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Stroke risk management: changes in mainstream practice
1Clinical and Health Services Studies Unit, King's College School of Medicine and Dentistry, London, UK.
Insights
Improved management of stroke risk factors like hypertension and atrial fibrillation is crucial for preventing ischemic events. This study shows a positive trend in risk factor control, though some events remain preventable.
Area of Science:
- Neurology
- Cardiology
- Public Health
Background:
- Identification and control of risk factors are proven to reduce ischemic stroke incidence.
- The real-world impact of evidence-based stroke prevention strategies on clinical practice is not well understood.
Purpose of the Study:
- To examine the management of pre-existing risk factors in patients diagnosed with acute cerebral infarction.
- To assess the appropriateness of prior risk factor management against established criteria.
Main Methods:
- Observational study analyzing data from 1,074 patients over three years.
- Collected data on the prevalence of hypertension, atrial fibrillation, prior stroke/TIA, and diabetes before the index stroke.
- Compared the proportion of patients receiving treatment for these risk factors over time.
Main Results:
- While the prevalence of hypertension, diabetes, and prior stroke/TIA remained stable, treatment rates for cerebrovascular disease, atrial fibrillation, ischemic heart disease, and carotid disease significantly increased over three years.
- Approximately 45% of atrial fibrillation patients, 60% of hypertension patients, and 70% of cerebrovascular disease patients were actively managed.
- Patients with symptomatic vascular disease received more appropriate risk management (72%) than asymptomatic patients (46%).
Conclusions:
- Despite a significant number of potentially preventable ischemic strokes, there is an encouraging trend towards better control of stroke risk factors.
- Continued efforts in risk factor management are essential for reducing the burden of ischemic stroke.
Background:
Research shows that identification and control of risk factors reduces ischemic stroke. The impact of this evidence and health initiatives on mainstream practice remains unknown.
Methods:
The purpose of this observational study was to investigate prior management of risk factors (hypertension, atrial fibrillation, previous stroke/transient ischemic attacks) in patients with acute cerebral infarction. Data were collected on the frequency of known risk factors before the incident stroke and their management compared with predefined criteria for appropriateness. The proportion of patients receiving treatment for risk factors before the acute episode was studied over 3 years.
Results:
One thousand seventy-four patients (median age, 76 years; 60% women) were included in the study over 3 years. The proportion of patients with known hypertension (41% to 46%), diabetes (12% to 13%), previous stroke or transient ischemic attack (TIA) (21% to 31%), and atrial fibrillation (16% to 21%) remained stable. Overall, approximately 45% patients with atrial fibrillation, 60% patients with hypertension, and 70% with cerebrovascular disease were being actively managed. Time trends analysis showed a significant increase in the proportion of patients being treated for risk due to known cerebrovascular disease (59% to 85%), atrial fibrillation (18% to 59%), ischemic heart disease (35% to 72%), and carotid disease (13% to 85%) between the first and third year. The proportion of patients receiving treatment for hypertension remained unchanged. Patients with preexisting symptomatic vascular disease were more likely to receive appropriate risk management compared with asymptomatic patients (72% versus 46%, P<.001).
Conclusions:
Although a significant number of ischemic events remain potentially preventable, there appears to be a positive trend in improved control of stroke risk.