Abstract 3794: Investigating Gender Differences in Secondary Stroke Prevention Care in Ontario
Introduction: In Ontario, more women than men (51% vs. 49% in 2009/10) are admitted for stroke or transient ischemic attack (TIA). Women are also older when they experience stroke or TIA (78 vs. 72 median years) and have strokes resulting in greater disability. Best practice stroke care indicates secondary stroke prevention is essential to reducing the likelihood of recurrent vascular events following stroke or TIA. There is currently limited information about whether or not gender differences exist in the type of care delivered at Secondary Stroke Prevention Clinics (SPCs). This study examined whether or not gender differences in the quality of care exist at SPCs across Ontario.
Methods: Subjects included all consecutive stroke/TIA patients seen at 21 of 33 designated SPCs in Ontario participating in the Registry of the Canadian Stroke Network’s Stroke Performance Indicators for Reporting Improvement & Translation (SPIRIT-SPC) web-based data collection. Patients with presumed stroke/TIA referred to SPCs between January 2007 and April 2011 were identified for this study. We excluded referrals not initiated as a direct result of an acute stroke/TIA event within the past 3 months, non-strokes, and incomplete referrals/visits. We compare the performance rate for seven quality of care indicators related to secondary prevention between men and women.
Results: Of the 14,966 stroke/TIA patients with at least one SPC visit, 47.2% were female and the mean age in years was 69 for women and 67 for men. Significant gender differences were found in referral reason and source, risk factors, and final diagnosis made after the first SPC visit. Women were more likely to be referred for query stroke (61.1% vs. 57.7%) and referred by an emergency or family physician (82.5% vs. 79.6%) compared to men. In terms of risk factors associated with stroke, compared to men, fewer women had a history of smoking; dyslipidemia, diabetes, and previous stroke, however, more females were obese. A higher percentage of women were diagnosed with TIA or query stroke after the first SPC visit (33.2% vs. 26.3%). Significant gender differences were observed in 3 of 7 performance indicators. Women had lower rates of neuroimaging (F=91.5%, M=92.6%, p<0.05), carotid imaging (F=87.4%, M=89.2%, p<0.05) and antithrombotics (F=91.2%, M=92.5%, p<0.05). No significant differences were found in access, time to assessment, and prescriptions for anticoagulants among patients with atrial fibrillation.
Conclusion: Women are less likely to receive diagnostic imaging and antithrombotic prescriptions at or prior to a SPC visit compared to males. As best practice stroke care recommends all patients with presumed stroke/TIA should receive appropriate diagnostic evaluation and treatment, there is a need to eliminate gender gaps in secondary prevention care.
- © 2012 by American Heart Association, Inc.