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The feasibility of assessing prognosis over 3 years in persons with a previous stroke/transient ischemic attack in
Eimear Ryan1, Harmeet Gill1, Róisín Doogue1
1School of Medicine, University of Limerick, Limerick, Ireland.
Insights
Conducting stroke and transient ischemic attack (TIA) prognosis studies in primary care is feasible. This research confirms general practices can support a well-powered observational study for post-stroke patient outcomes.
Area of Science:
- Neurology
- Cardiovascular Medicine
- Primary Care Research
Background:
- Stroke significantly impacts survivors, with hypertension as a key modifiable risk factor managed primarily in general practice.
- Most stroke research is not conducted in primary care settings, despite ongoing concerns about recurrent stroke risk.
- Assessing prognosis in patients with a history of stroke or transient ischemic attack (TIA) within general practice is crucial.
Purpose of the Study:
- To determine the feasibility of assessing prognosis in patients with a previous stroke or TIA within a general practice setting.
- To evaluate the possibility of conducting a well-powered observational study in primary care for post-stroke/TIA patients.
Main Methods:
- A retrospective electronic health record review of patients with a history of stroke or TIA was conducted.
- Feasibility was assessed based on practice participation, patient record accessibility, outcome availability, data collection time per patient, and the ability to perform a power calculation.
- Five specific criteria were established to evaluate the feasibility of the proposed methodology.
Main Results:
- All six approached general practices participated, with 98.5% of patient records successfully re-identified.
- An average of 5.5 minutes per patient file was required for data collection, well within the 15-minute target.
- Twenty-eight cardiovascular events were recorded, predominantly recurrent TIAs or ischemic strokes, enabling a power calculation for a future study.
Conclusions:
- The methodology for a comprehensive cohort study in general practice for post-stroke/TIA patients is both acceptable and feasible.
- An adequately powered, time-to-event observational study is possible within the primary care setting.
- This study validates general practice as a viable setting for crucial stroke and TIA prognosis research.
Background:
Stroke has devastating consequences for survivors. Hypertension is the most important modifiable risk factor, and its management largely takes place in primary care. However, most stroke-based research does not occur in this setting. Ongoing hypertension and a risk of further stroke are a major concern for both patients and their general practitioners. We aim to assess whether it is feasible to assess prognosis in persons, with a previous stroke or transient ischemic attack (TIA), in general practice, and whether a well-powered observational study is possible.
Methods:
We performed a search of the electronic health record of individuals previously identified as having had a stroke or TIA, to assess prognosis over 3 years. Feasibility was assessed by meeting five criteria: (1) all general practices approached participated, (2) greater than 90% of patient records were accessible, (3) all study outcomes were available to review, (4) that collection data was less than 15 min per patient, and (5) a power calculation for a planned observational study could take place.
Results:
All six general practices approached participated freely, and 193/196 patients' files were reidentified (98.5%). Twenty-eight cardiovascular events were recorded-most commonly a repeat TIA or ischemic stroke. Data collection took on average 5.5 min per file, and a power calculation for a planned observational study was completed.
Conclusion:
This study demonstrates that the proposed methodology for a full cohort study within general practice of patients post-stroke/TIA is both acceptable to practices and feasible. An adequately powered, "time-to-event" study is possible.
