Stroke and Transient Ischemic Attack in the Long-Term Care Setting: Patient Characteristics, Medication Treatment, and Length of Stay

OBJECTIVE: To examine the percentage of patients treated with antiplatelet or anticoagulant therapy among patients with stroke or transient ischemic attack (TIA) in the long-term care setting. DESIGN: Data were taken from the Minimum Data Set. Information regarding medications was derived from a linked pharmacy-claims database. SETTING: Long-term care facilities. PATIENTS, PARTICIPANTS: Residents of long-term care facilities with stroke or TIA as indicated in the database between January 1, 2007, and December 31, 2008, were selected; 14,469 patients with stroke and 833 patients with TIA were identified. INTERVENTIONS: None. MAIN STUDY VARIABLES: Demographics, admission and payer source, residential history, quality measures, comorbidities, and antiplatelet and anticoagulant therapies received. RESULTS: Approximately 48% of stroke patients and 53% of TIA patients received any antiplatelet or anticoagulant medication. Stroke patients had a mean (standard deviation [SD]) of 19.5 (73.2) days from their first assessment to their first medication, and they received therapy for a mean (SD) of 112.3 (258.3) days. TIA patients had a mean (SD) of 13.7 (54.9) days from their first assessment to their first medication, and they received therapy for a mean (SD) of 67.0 (165.7) days. In both cohorts, clopidogrel was the most common therapy received (22.5% of stroke patients and 24.6% of TIA patients). CONCLUSIONS: Health care providers treating patients in the long-term care setting should be aware of the population characteristics and high rate of undertreatment observed in this analysis. This study may help inform optimal decision-making by physicians and other health care practitioners.