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[Compliance with recommendations in secondary prevention of stroke in primary care]
Carmen Tamayo-Ojeda1, Neus Parellada-Esquius2, Betlem Salvador-González3
1ABS Sant Boi Camps Blancs, SAP Baix Llobregat Centre, DAP Costa de Ponent, Institut Català de la Salut, Sant Boi de Llobregat, Barcelona, España.
Insights
Compliance with secondary stroke prevention guidelines in primary care needs improvement, particularly for younger patients. Enhanced strategies and professional engagement are crucial for better adherence and outcomes.
Area of Science:
- Cardiology
- Neurology
- Primary Care Medicine
Background:
- Secondary prevention of stroke is critical for reducing recurrence and improving patient outcomes.
- Primary care settings play a vital role in implementing and monitoring these preventive strategies.
- Current adherence to established stroke prevention guidelines in primary care requires evaluation.
Purpose of the Study:
- To assess compliance with secondary stroke prevention recommendations within primary care.
- To identify factors influencing patient compliance with these recommendations.
Main Methods:
- A multi-center, cross-sectional study was conducted in primary care centers serving a large metropolitan population.
- Data from 21,976 patients (aged 18+) with ischemic brain disease diagnosed at least six months prior were analyzed.
- Compliance was defined by blood pressure (<140/90 mmHg), LDL-cholesterol (<100 mg/dL), smoking cessation, and prescription of key preventive medications.
Main Results:
- Optimal blood pressure control was achieved in 65.7% and LDL-cholesterol control in 41.0% of patients.
- Smoking cessation was recorded in 3.7% of patients.
- Prescription rates for anti-platelets/anticoagulants, statins, and ACE inhibitors/ARBs/diuretics were high (86.2%, 61.3%, 61.8% respectively).
- Risk factor control was better in older age groups (66-79 years) and poorer in younger adults (18-40 years).
Conclusions:
- Implementation of secondary stroke prevention guidelines in primary care requires significant improvement, especially for younger populations.
- Organizational changes, increased professional engagement, and strategies to overcome therapeutic inertia are necessary.
- Targeted interventions are needed to enhance adherence and optimize secondary stroke prevention across all age groups.
Objective:
Knowing compliance with secondary prevention recommendations of stroke in primary care and to identify factors associated with compliance.
Design:
Multi-centre cross-sectional.
Setting:
Health primary care centres in a metropolitan area (944,280 inhabitants).
Participants:
Patients aged 18years and over with ischemic brain disease diagnosis prior to 6months before the study.
Main Measurements:
Clinical history records of demographic variables, risk factors and cardiovascular comorbidity, drugs, blood pressure values (BP), LDL-cholesterol and medical visits by doctor and nurses after the event. Good adherence was considered when BP <140/90 mmHg, LDL-cholesterol <100 mg/dL, smoking abstention and preventive drugs prescription (anti-platelet/anticoagulants, statins and angiotensin-converting-enzyme inhibitors/angiotensin-receptor-antagonists or diuretics) during the last 18months.
Results:
A total of 21,976 patients, mean age 73.12 years (SD: 12.13), 48% women, 72.7% with stroke. Co-morbidity: hypertension 70.8%, dyslipidemia 55.1%, DM 30.9%, atrial fibrillation 14.1%, ischemic heart disease 13.5%, chronic renal failure 12.5%, heart failure 8.8%, peripheral arterial disease 6.2%, dementia 7.8%. No record was found for smoking in 3.7%, for BP in 3.5% and for LDL in 6.5%. Optimal control: abstention smoking in 3.7%, BP <140/90 in 65.7% and LDL <100 mg/dL in 41.0%.
Treatment:
86.2% anti-platelet/anticoagulants, 61.3% statins and 61.8% angiotensin-converting-enzyme inhibitors, angiotensin-receptor-antagonists or diuretic. Registration and risk factors control was higher in 66-79years aged and lower in 18-40years aged.
Conclusions:
The implementation of clinical guidelines recommendations for stroke prevention in primary care must be improved, especially among younger population. Organizational changes and more active involvement by professionals and strategies against therapeutic inertia must be taken.