Assessing the impact of frailty on statin prescriptions among older stroke survivors with and without diabetes in Malaysia

Background Statins are crucial in secondary prevention for patients post strokes. Frailty may influence prescribing decisions for statins, and the interaction between frailty and diabetes in the context of statin use remains unexplored. Aim This study aimed to examine the relationship of frailty and statin prescriptions in older participants with stroke, and to compare statin prescription rates and the impact of frailty on statin prescriptions between participants with and without type 2 diabetes. Methods A cross-sectional study was conducted in older patients with ischemic stroke in a tertiary hospital in Malaysia. Frailty assessments prior to discharge from hospital were determined using the Clinical Frailty Scale version 2.0. Odds ratios (ORs) were estimated from logistic regression models to examine the relationship between frailty and the prescription of statins. Results There were 282 participants (mean age 80.8, SD 6.3), 132 with diabetes and 162 were female. The mean CFS score was 6.1 (SD 1.1) in all participants, 6.0 (SD 1.1) in participants without diabetes, and 6.2 (SD 1.0) in participants with diabetes (p=0.099). The percentages of frailty (defined with a CFS ≥4) were 97.2% in all participants, 96.0% in those without diabetes vs 98.5% in those with diabetes (p=0.290). Statin was the most commonly prescribed medication at discharge (69.0%), followed by antiplatelets (65.5%), calcium channel blockers (38.4%). There was no significant difference on statin prescription rates between participants with and without diabetes (71.0% vs. 67.3%, p=0.508). Increased CFS score was significantly associated with reduced odds of receiving statins in all participants (adjusted OR 0.64, 95% CI 0.46-0.88), and in participants without diabetes (adjusted OR 0.54, 95% CI 0.33–0.89), but not in participants with diabetes (adjusted OR 0.73, 95%CI 0.46–1.17). Conclusion Frailty was associated with reduced odds of receiving statins in the study population. The differences in the relationship between frailty and statin prescriptions among participants with and without diabetes may suggest a personalized approach in secondary prevention for older patients after strokes. Future studies are needed to understand prescribers’ perspectives, aiding in the development of personalized healthcare for older individuals.