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Setting Up a Stroke Team Algorithm and Conducting Simulation-based Training in the Emergency Department - A Practical Guide
Published on: January 15, 2017
Secondary stroke prevention: practice patterns in a tertiary care stroke service
Janice C Fan1, Tania M Mysak, Thomas J Jeerakathil
1Pharmacy Department, North York General Hospital, Toronto, Ontario.
Summary
Secondary stroke prevention care has high compliance for antithrombotic and antihypertensive therapies but needs improvement for lipid-lowering agents and smoking cessation. Further strategies are needed to minimize care gaps and optimize stroke prevention.
Area of Science:
- Neurology
- Cardiovascular Medicine
- Public Health
Background:
- Stroke and transient ischemic attack (TIA) pose significant personal and financial burdens, necessitating effective prevention strategies.
- Limited data exists on secondary preventative care gaps within Canada outside of Ontario registries.
- Evaluating compliance with secondary stroke prevention interventions is crucial for improving patient outcomes.
Purpose of the Study:
- To assess inpatient medical team adherence to four key secondary stroke prevention interventions.
- The interventions evaluated include antithrombotic therapy, antihypertensive therapy, lipid-lowering therapy, and smoking cessation.
- This study aims to identify potential care gaps in stroke prevention within a Canadian hospital setting.
Main Methods:
- Retrospective chart review of adult patients admitted with stroke or TIA at the University of Alberta Hospital between August 2005 and July 2006.
- International Classification of Diseases (10th Revision) codes were used to identify eligible patients.
- Compliance was defined as achieving therapeutic targets or receiving appropriate therapy for subtherapeutic targets, assessed in 200 randomly selected charts.
Main Results:
- The study included 190 eligible patients, with 77.4% experiencing non-cardioembolic and 22.6% cardioembolic events.
- High compliance rates were observed for antithrombotic (92%) and antihypertensive (95%) therapies.
- Suboptimal compliance was noted for lipid-lowering agents (68%) and smoking cessation (27%).
Conclusions:
- Despite specialized stroke centers, opportunities exist to enhance early risk factor management for secondary stroke prevention.
- Interdisciplinary collaboration, investigation into suboptimal care reasons, and targeted strategies are essential to minimize care gaps.
- Continuous quality improvement through ongoing stroke care audits is recommended to optimize preventative care.
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