Prevalence of Undiagnosed Risk Factors in Patients with First-Ever Ischemic Stroke Treated at MUHC: A Retrospective
Shorog Althubait1, Heather Perkins2, Robert Cote2
1Neurology, College of Medicine, King Khalid University, Abha 61413, Saudi Arabia.
Insights
Lack of a family doctor is linked to higher rates of undiagnosed hypertension in first-time ischemic stroke patients. Improving primary care access can aid early detection and management of stroke risk factors.
Area of Science:
- Neurology
- Public Health
- Epidemiology
Background:
- Ischemic stroke remains a major global cause of death and disability.
- Many patients experience their first stroke with undiagnosed vascular risk factors (URFs), indicating missed early detection opportunities.
- Inconsistent primary care access in Quebec, Canada, leaves many without a family doctor (FD).
Purpose of the Study:
- To determine the prevalence of URFs in patients with first-ever ischemic stroke.
- To evaluate the relationship between URFs, geographic region, and primary care access (FD status) in Quebec.
- To test the hypothesis that patients without an FD have a higher URF prevalence.
Main Methods:
- Retrospective chart review of 610 patients with first-ever ischemic stroke at MUHC (2014-2017).
- Collected data included demographics, URFs (hypertension, diabetes, hyperlipidemia, atrial fibrillation), FD status, and geographic location.
- Statistical analysis compared URF prevalence based on FD status and region.
Main Results:
- 136 (22.3%) patients had at least one URF; hyperlipidemia was most common (14.3%).
- 146 (23.97%) patients lacked an FD.
- Patients without an FD showed significantly higher rates of undiagnosed hypertension (7.6% vs. 2.1%, p=0.008).
Conclusions:
- A lack of a family doctor is associated with increased prevalence of undiagnosed hypertension in ischemic stroke patients.
- Targeted screening and enhanced primary care access, especially in underserved areas, can improve early identification and management of modifiable stroke risk factors.
- This approach may reduce the burden of preventable strokes.
Abstract:
Background: Ischemic stroke is a leading cause of morbidity and mortality worldwide. Despite established prevention strategies, many patients present with previously undiagnosed vascular risk factors (URFs) at the time of their first-ever ischemic stroke, suggesting missed opportunities for early detection. In Canada, particularly in Quebec, access to primary care is inconsistent, and a substantial proportion of the population lacks attachment to a family doctor (FD). Objective: This study aimed to determine the prevalence of URFs among patients with first-ever ischemic stroke and to evaluate the relationship between URFs, geographic region, and access to primary care in Quebec, Canada. We hypothesized that patients without an FD would have a higher prevalence of URFs. Methods: We conducted a retrospective chart review of 610 patients admitted with first-ever ischemic stroke to the McGill University Health Center (MUHC) between 2014 and 2017. Data collected included demographics; known and undiagnosed stroke risk factors such as hypertension (HTN), diabetes mellitus (DM), hyperlipidemia (HLD), and atrial fibrillation (AF); FD status; and geographic location based on postal code. Results: Among the 610 patients, 136 (22.3%) had at least one URF. The most common URF was HLD (14.3%), followed by HTN (6.2%), AF (1.6%), and DM (0.1%). Of 609 patients with available data, 146 (23.97%) lacked an FD. Patients without an FD were significantly more likely to have undiagnosed HTN (7.6% vs. 2.1%, p = 0.008). No significant differences were observed for the other URFs. Geographic variation was noted in both URF prevalence and FD access, but regional differences were not statistically significant. Conclusions: Our findings support the hypothesis that a lack of an FD is associated with a higher prevalence of undiagnosed HTN in ischemic stroke patients. Targeted screening and improved access to primary care, particularly in underserved regions, may help to reduce the burden of preventable stroke by facilitating the earlier identification and management of modifiable risk factors.
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