Secondary Prevention Medications

EHR dispensing data cannot capture clinical contraindications, patient frailty, or end-of-life decisions, so lower dispensing rates may partly reflect appropriate clinical decision-making. The gap in antihypertensive prescribing predates and persists through the COVID-19 pandemic, confirming it is a structural rather than crisis-related problem. Antiplatelet and anticoagulant dispensing rates were stable across 2020 to 2023. Antihypertensive and lipid-lowering dispensing increased modestly over the study period, suggesting gradual quality improvement. Antihypertensive dispensing remains below 50% in both ischaemic and haemorrhagic stroke despite clinical evidence supporting a target systolic blood pressure of 125 mmHg or lower. Only 77.1% of patients with pre-existing atrial fibrillation and ischaemic stroke received an anticoagulant within one year, falling below guideline expectations. Older patients were significantly less likely to receive lipid-lowering or antihypertensive medication after adjustment, but age did not affect anticoagulant or antiplatelet dispensing.