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The Avoid Stroke as Soon as Possible (ASAP) general practice stroke audit
Jonathan W Sturm1, Stephen M Davis, John G O'Sullivan
1National Stroke Research Institute and Department of Neurology, Austin and Repatriation Medical Centre, West Heidelberg, VIC.
Insights
Stroke risk factors are common in general practice, with hypertension and high cholesterol being most prevalent. Improved management strategies are needed to reduce stroke incidence.
Area of Science:
- Cardiovascular epidemiology
- General practice research
- Public health
Background:
- Stroke remains a leading cause of disability and mortality.
- Effective management of modifiable risk factors is crucial for primary stroke prevention.
- General practice settings offer opportunities for early detection and intervention.
Purpose of the Study:
- To determine the prevalence of key stroke risk factors in an Australian general practice population.
- To identify current pharmacotherapy use for managing these risk factors.
- To establish a baseline for future stroke prevention initiatives.
Main Methods:
- A multicentre, observational study involving 321 general practitioners across Australia.
- Data collected from 16,148 consecutive patients aged 30 years and older.
- Assessed prevalence of hypertension, hypercholesterolaemia, diabetes, smoking, atrial fibrillation, and prior stroke/TIA, alongside pharmacotherapy use.
Main Results:
- 70% of patients had at least one stroke risk factor; 34% had two or more.
- Hypertension (44%) and hypercholesterolaemia (43%) were the most prevalent risk factors.
- Pharmacotherapy use included cardiovascular agents (e.g., ACE inhibitors) and antiplatelet agents, with two-thirds of hypertensive patients receiving treatment.
Conclusions:
- Stroke risk factors are highly prevalent in primary care patients.
- General practitioners are well-positioned for opportunistic screening and risk factor management.
- Significant opportunities exist to enhance the management of stroke risk factors in primary care.
Objectives:
To determine the prevalence of stroke risk factors in a general practice population and to identify pharmacotherapies currently used in management of stroke risk factors.
Design:
Multicentre, observational study by 321 randomly selected general practitioners who each collected data on 50 consecutive patients attending their surgery.
Patients And Setting:
16 148 patients aged 30 years or older attending general practices across Australia during 2000.
Outcome Measures:
Prevalence of hypertension, current smoking, diabetes, hypercholesterolaemia, atrial fibrillation, recent history of stroke or TIA; extent of pharmacotherapy use in risk-factor management.
Results:
70% of patients had one or more risk factors and 34% had two or more. Hypertension was the risk factor with greatest prevalence (44%), followed by hypercholesterolaemia (43%) and current smoking (17%). The prevalence of risk factors generally increased with age, except for current smoking, where a decrease with age was seen. The most common pharmacotherapies were cardiovascular agents, followed by antiplatelet agents. Two-thirds of patients with hypertension were taking cardiovascular drugs, most commonly angiotensin-converting enzyme inhibitors.
Conclusions:
Stroke risk factors are highly prevalent in general practice patients and GPs are ideally placed for opportunistic case-finding. There is considerable scope for improving management of stroke risk factors. The Avoid Stroke as Soon as Possible (ASAP) general practice stroke audit provides a baseline against which progress in risk-factor management can be measured.