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Stroke prevention: missed opportunities?
Insights
Many stroke patients have poorly managed risk factors before hospital admission. This study highlights missed opportunities for stroke prevention due to inadequate identification and control of modifiable risk factors.
Area of Science:
- Neurology
- Cardiovascular Medicine
- Public Health
Background:
- Stroke prevention relies on identifying and managing modifiable risk factors.
- Acute stroke admission presents an opportunity to identify previously unrecognized risk factors.
Purpose of the Study:
- To assess the pre-admission identification and management of modifiable stroke risk factors in patients admitted with acute stroke.
- To determine the prevalence of new modifiable risk factors discovered post-stroke.
Main Methods:
- Prospective assessment of 100 consecutive stroke patients admitted to a UK hospital.
- Evaluation of pre-admission management of identified modifiable risk factors.
Main Results:
- High rates of unmanaged risk factors including hypertension, diabetes, smoking, atrial fibrillation, and obesity.
- Effective pre-admission management was documented for only a subset of identified risk factors.
- Twenty-five new modifiable risk factors were identified after the stroke event.
Conclusions:
- A significant gap exists between evidence-based stroke prevention guidelines and community practice.
- Many opportunities for secondary stroke prevention are missed due to poor risk factor control.
- Improved community-based identification and management of modifiable risk factors are crucial for stroke prevention.
Abstract:
Identification and modification of risk factors can prevent strokes. Certain previously unidentified risk factors for stroke can become apparent following admission with acute stroke. The aim of the study was to investigate the prior capture, identification and management of modifiable risk factors for stroke in patients admitted to a hospital following acute stroke. One hundred consecutive stroke patients admitted to a UK hospital were prospectively assessed for modifiable risk factors. The extent of pre-admission risk factor management was also determined. Pre-admission risk factors identified and effectively managed were hypertension in non-diabetics (28%), hypertension in diabetics (7%), previous cerebrovascular event (100%), diabetes (29%), smoking (50% counselled), atrial fibrillation (81%), hypercholesterolaemia (100%), excess alcohol (22% counselled) and obesity (52% counselled). Twenty-five new modifiable risk factors were identified following incident stroke. In conclusion, a significant number of patients admitted with acute stroke have their risk factors poorly identified and controlled in the community. Despite the trial evidence available, an evidence-practice gap exists and many stroke prevention opportunities are being missed.