scholarly journals Secondary Stroke Prevention: Practice Patterns in a Tertiary Care Stroke Service

2010 ◽  
Vol 37 (2) ◽  
pp. 245-251 ◽  
Author(s):  
Janice C. Fan ◽  
Tania M. Mysak ◽  
Thomas J. Jeerakathil ◽  
Glen J. Pearson
Keyword(s):  
Smoking Cessation ◽  
Stroke Prevention ◽  
Tertiary Care ◽  
Lipid Lowering ◽  
Lipid Lowering Therapy ◽  
Secondary Stroke Prevention ◽  
Preventative Care ◽  
Stroke Service ◽  
Care Gaps ◽  
Cerebral Event

Background:Stroke and transient ischemic attack (TIA) have a high personal and financial cost to society and prevention is critical. Outside of registries in Ontario, there has been little effort to determine whether care gaps exist for secondary preventative care within Canada. The objective of this study was to evaluate inpatient medical team compliance to four secondary stroke prevention interventions: antithrombotic therapy, antihypertensive therapy, lipid lowering therapy and smoking cessation.Methods:Adults admitted to the University of Alberta Hospital stroke service with a diagnosis of stroke or TIA between August 1st, 2005 and July 31st, 2006 were identified using International Classification of Diseases (10th Revision) codes. Two hundred charts were randomly selected for retrospective review. Compliance, defined as achievement of therapeutic targets or appropriate therapy for subtherapeutic targets, was assessed.Results:Among 190 eligible patients (mean age 67 years, 55 % male), 147 (77.4%) had a non-cardioembolic cerebral event while 43 (22.6%) had a cardioembolic cerebral event. We found high compliance for antithrombotic (92% [174/190]) and antihypertensive (95% [136/143]) agents, but suboptimal compliance for lipid lowering agents (68% [107/158]) and smoking cessation (27% [17/64]).Conclusions:There is room for improvement in early risk factor management for secondary prevention, even in specialized stroke centres. To optimize stroke preventative care, more interdisciplinary collaboration, investigation of reasons for suboptimal care, development of strategies to minimize care gaps and ongoing stroke care audits for quality improvement are needed.

scholarly journals Stroke Prevention: Little-Known and Neglected Aspects

2021 ◽  
pp. 1-14
Author(s):  
M. Reza Azarpazhooh ◽  
Chrysi Bogiatzi ◽  
J. David Spence
Keyword(s):  
Stroke Prevention ◽  
Oral Anticoagulants ◽  
Blood Pressure Reduction ◽  
The Elderly ◽  
Lipid Lowering ◽  
Lipid Lowering Therapy ◽  
Enteric Coating ◽  
Asymptomatic Carotid ◽  
Lowering Therapy ◽  
Direct Acting

Combining available therapies has the potential to reduce the risk of stroke by 80% or more. A comprehensive review of all aspects of stroke prevention would be very lengthy; in this narrative review, we focus on some aspects of stroke prevention that are little-known and/or neglected. These include the following: (1) implementation of a Mediterranean diet; (2) B vitamins to lower homocysteine; (3) coordinated approaches to smoking cessation; (4) intensive lipid-lowering therapy; (5) lipid lowering in the elderly; (6) physiologically individualized therapy for hypertension based on renin/aldosterone phenotyping; (7) avoiding excessive blood pressure reduction in patients with stiff arteries; (8) treatment of insulin resistance with pioglitazone in stroke patients with prediabetes and diabetes; (9) impaired activation of clopidogrel in patients with variants of CYP2C19; (10) aspirin pseudoresistance due to enteric coating; (11) rationale for anticoagulation in patients with embolic stroke of unknown source; (12) pharmacologic properties of direct-acting oral anticoagulants that should be considered when choosing among them; (13) the identification of which patients with asymptomatic carotid stenosis are at a high enough risk to benefit from carotid endarterectomy or stenting; and (14) the importance of age in choosing between endarterectomy and stenting. Stroke prevention could be improved by better recognition of these issues and by implementation of the principles derived from them.

Abstract TMP68: Vulnerability to Health Disparities and Secondary Stroke Prevention: The REGARDS Study

Stroke ◽  
2016 ◽  
Vol 47 (suppl_1) ◽  
Author(s):  
James. D Rhodes ◽  
Asikhame Oikeh ◽  
Chris Gamboa ◽  
Abimbola Fadairo ◽  
Suzanne Judd ◽  
...  
Keyword(s):  
Health Disparities ◽  
Stroke Prevention ◽  
Healthcare Providers ◽  
Lipid Lowering ◽  
Inverse Association ◽  
Secondary Stroke Prevention ◽  
Stroke Event ◽  
Point Increase ◽  
National Cohort ◽  
Regards Study

There are few studies on the effect of multiple vulnerabilities to health disparities identified in the AHRQ 2012 report on secondary stroke prevention. We examined the effects of 5 vulnerability domains (race, age, region, health insurance and income) on the prescription of secondary stroke prevention medications at discharge following hospitalization for an acute ischemic stroke (AIS) in a large, national cohort of patients admitted to unselected hospitals. Methods: We conducted a retrospective review of admissions for AIS between 2003-2012 within the REGARDS cohort. Discharge medications, insurance status, and age at time of stroke event were obtained from hospital records. Race, region and income < $20,000 were obtained from REGARDS baseline data. We constructed a vulnerability score (v score) range from 0-5, with 0 indicating no vulnerability. We examined the prevalence of each discharge medication by each vulnerability domain, score category, and by overall score using Poisson regression with a robust variance estimator. Results: 664 participants met the inclusion criteria. 132 (20%) of the study participants had ≥ 3 vulnerabilities (v score of 3-5). Participants with ≥ 3 vulnerabilities were more likely to be black (80.3%), > 75 years old (63.6%), and to report income < $20,000 (67.4%). The prevalence of receiving antithrombotic prescriptions at discharge was significantly lower in participants with ≥ 3 vulnerability domains (PR: 0.90 [95% CI: 0.82, 0.99]). The prevalence of receiving antithrombotic prescriptions was also inversely associated with a per point increase of the v score (PR: 0.96 [95% CI: 0.93, 0.99]), as were lipid- lowering prescriptions at discharge (PR: 0.95 [CI: 0.90, 0.99]). There was a non-statistically significant inverse association between ACEi/ARB prescriptions at discharge and having multiple vulnerabilities, including for 2 vulnerabilities (PR: 0.93 [CI: 0.80, 1.09]) and for ≥ 3 vulnerabilities (PR: 0.84 [CI: 0.69, 1.01]). Conclusion: The presence of multiple vulnerabilities was associated with lower adherence by healthcare providers to secondary stroke prevention recommendations for discharge prescriptions.

scholarly journals Secondary Stroke Prevention in Polish Adults: Results from the LIPIDOGRAM2015 Study

2021 ◽  
Vol 10 (19) ◽  
pp. 4472
Author(s):  
Beata Labuz-Roszak ◽  
Maciej Banach ◽  
Michal Skrzypek ◽  
Adam Windak ◽  
Tomasz Tomasik ◽  
...  
Keyword(s):  
Stroke Prevention ◽  
Lifestyle Modification ◽  
Antihypertensive Drugs ◽  
Lipid Lowering ◽  
Secondary Stroke Prevention ◽  
Anticoagulant Treatment ◽  
Place Of Residence ◽  
Anticoagulation Agents ◽  
Preventive Medication ◽  
History Of

Background: The purpose of the study was to evaluate secondary stroke prevention in Poland and its association with sociodemographic factors, place of residence, and concomitant cardiovascular risk factors. Material and methods: From all patients in LIPIDOGRAM2015 Study (n = 13,724), 268 subjects had a history of ischaemic stroke and were included. Results: 165 subjects (61.6%) used at least one preventive medication. Oral antiplatelet and anticoagulation agents were used by 116 (43.3%) and 70 (26.1%) patients, respectively. Only 157 (58.6%) participants used lipid-lowering drugs, and 205 (76.5%) were treated with antihypertensive drugs. Coronary heart disease (CHD) and dyslipidaemia were associated with antiplatelet treatment (p = 0.047 and p = 0.012, respectively). A history of atrial fibrillation, CHD, and previous myocardial infarction correlated with anticoagulant treatment (p = 0.001, p = 0.011, and p < 0.0001, respectively). Age, gender, time from stroke onset, place of residence, and level of education were not associated with antiplatelet or anticoagulant treatment. Only 31.7% of patients were engaged in regular physical activity, 62% used appropriate diet, and 13.6% were current smokers. Conclusions: In Poland drugs and lifestyle modification for secondary stroke prevention are not commonly adhered to. Educational programmes for physicians and patients should be developed to improve application of effective secondary prevention of stroke.

scholarly journals Cross-sectional study of pattern of Dyslipidemia and Prevalence of Atherogenic Diabetic Dyslipidemia in newly detected Diabetic patients

2019 ◽  
Vol 10 (6) ◽  
pp. 45-49
Author(s):  
Vinay Krishnamurthy ◽  
Akhila Rao Kerekoppa ◽  
Prabhakar B
Keyword(s):  
Tertiary Care ◽  
Hdl Cholesterol ◽  
Cross Sectional Study ◽  
Lipid Lowering ◽  
Diabetic Patients ◽  
Lipid Lowering Therapy ◽  
Newly Diagnosed ◽  
Diabetic Dyslipidemia ◽  
Cross Sectional ◽  
Treatment Naïve

Background: India has seen an ever increasing number of diabetic patients and in turn rise in cardiovascular diseases. Many studies have shown diabetic patients to have dyslipidemia, with certain common patterns early in the disease. Aims and Objective: The current study was done to identify pattern of dyslipidemia and prevalence of ADD in treatment naïve diabetic patients. Material and Methods: Fasting lipid profile was analysed in treatment naïve diabetic patients at a tertiary care teaching hospital. Various factors influencing the results were analysed statistically. Results: Prevalence of dyslipidemia was 89.2%, whereasatherogenic diabetic dyslipidemia was seen in 34.2% and raised non-HDL cholesterol in 73.3%. Conclusion: Our study showed a high prevalence of dyslipidemia in newly diagnosed diabetics indicating the importance of screening for dyslipidemia in newly diagnosed cases and implementation of timely lipid lowering therapy to prevent CVD. It also highlights the importance of pattern of dyslipidemia called Atherogenic diabetic dyslipidemia and raised Non-HDL cholesterol in diabetic patients.

Stroke prevention with lipid-lowering therapy

2004 ◽  
Vol 4 (2) ◽  
pp. 233-239 ◽  
Author(s):  
Bartlomiej Piechowski-Jozwiak ◽  
Julien Bogousslavsky
Keyword(s):  
Stroke Prevention ◽  
Lipid Lowering ◽  
Lipid Lowering Therapy ◽  
Lowering Therapy

scholarly journals Stroke Prevention and Sodium Restriction

2008 ◽  
Vol 35 (3) ◽  
pp. 278-279 ◽  
Author(s):  
Norman RC Campbell ◽  
J David Spence
Keyword(s):  
Stroke Prevention ◽  
Task Force ◽  
Population Attributable Risk ◽  
Cost Effective ◽  
Personal Communication ◽  
Pressure Control ◽  
Dominant Strategy ◽  
Lipid Lowering ◽  
Effective Control ◽  
Lipid Lowering Therapy

Stroke prevention is extremely cost-effective. The Ontario Task Force for the Coordinated Stroke Strategy for Ontario received from Dr. Muhammad Mamdani of the Institute for Clinical Evaluative Sciences the estimate that stroke prevention is approximately ten times more cost-effective than treating acute stroke with tPA.1 Hackam and Spence2 have calculated that in the highest-risk patients it would be possible to reduce the risk of stroke by more than 90% by a combination of interventions (including blood pressure control, smoking cessation, diet, treatment of diabetes, lipid-lowering therapy, and for patients in whom it is indicated, anticoagulation for atrial fibrillation or carotid endarterectomy). Dr Mukul Sharma (personal communication) has shown that stroke prevention is a dominant strategy in health economic terms; i.e. that it improves outcomes while reducing net costs. Effective control of hypertension has the potential to reduce stroke by half.3,4 Because hypertension is so prevalent, it accounts for the greatest population attributable risk for stroke, and thus represents the greatest opportunity to reduce stroke.

Sign in / Sign up

Export Citation Format

Share Document