Abstract
Background: Stroke is one of the top contributors to burden of disability-adjusted life-years worldwide. Family physicians have key role in optimal secondary prevention post-stroke helping patients make appropriate lifestyle changes and take medication in accordance with the recommended clinical practice guidelines.Methods: Our aim was to characterize the profile of patients who were being managed in primary care setting for secondary prevention of stroke. Our specific objectives were: (i) to examine the level of overall and individual risk factors control after an index-stroke event in patients visiting the primary care setting and (ii) to describe the factors associated with the achievement of overall risk factors control in post-stroke patients.Study Design: Retrospective cohort study.We conducted a study looking retrospectively at records from our electronic chronic disease database. Our study included post-stroke patients who visited public primary care setting in Singapore between 1st January 2012 to 31st December 2016. Based on AHA Stroke guidelines, we operationalized our outcome of secondary prevention post-stroke as overall control, which comprised of patients having blood pressure, lipids, and glucose reading (for those who had diabetes) all well-controlled. We conducted descriptive analysis and performed multivariable logistic analysis to determine factors associated with overall control.Results: There were 24,240 patients in our study. Overall control was better in post-stroke patients without diabetes (49.2%) as compared to those with diabetes (28.1%).Among post-stroke patients without diabetes, factors significantly associated with overall control were sex [OR: 1.23, 95% CI: 1.10, 1.39], ethnicity [OR: 0.72, 95% CI: 0.58, 0.90], BMI [OR: 0.72, 95% CI: 0.62, 0.84) and atrial fibrillation [OR: 1.47, 95% CI: 1.21, 1.78].Among post-stroke patients with diabetes, factors significantly associated with overall control were sex [OR: 1.28, 95% CI: 1.12, 1.46], ethnicity, BMI, atrial fibrillation[OR: 1.24; 95% CI: 1.02, 1.51], chronic kidney disease and smoking status.Conclusion: We reported a sub-optimal level of overall control. Among post-stroke patients, those with diabetes had a higher proportion of sub-optimal control as compared to those without diabetes. Irrespective of diabetic status, being female, having high BMI, and of Malay ethnicity were associated with poor overall control compared to Chinese.
Secondary Prevention Post Stroke in Primary Care in an Asian Setting: A Retrospective Cohort Study
