title: Local confidential inquiry into avoidable factors in deaths from stroke and hypertensive disease.
abstract: OBJECTIVE
  To audit avoidable deaths from stroke and hypertensive disease.
  
  
  METHODS
  Details of care before death were obtained from general practitioners and other doctors, anonymised, and assessed by two experts against agreed minimum standards of good practice for detecting and managing hypertension.
  
  
  METHODS
  Health authority with population of 250,000.
  
  
  METHODS
  All patients under 75 years who died of stroke, hypertensive disease, or hypertension related causes during November 1990 to October 1991.
  
  
  METHODS
  Presence of important avoidable factors and departures from minimum standards of good practice.
  
  
  RESULTS
  Adequate information was obtained for 88% (123/139) of eligible cases. Agreement between the assessors was mostly satisfactory. 29% (36/123, 95% confidence interval 21% to 37%) of all cases and 44% (36/81, 34% to 55%) of those with definite hypertension had avoidable factors that may have contributed to death. These were most commonly failures of follow up and continuing smoking. Assessment against standards of minimum good practice showed that care was inadequate but not necessarily deemed to have contributed to death, in a large proportion of patients with definite hypertension. Common shortcomings were inadequate follow up, clinical investigation, and recording of smoking and other relevant risk behaviours.
  
  
  CONCLUSIONS
  This method of audit can identify shortcomings in care of patients dying of hypertension related disease.
authors.affiliation: Department of Public Health, Rotherham Health Authority.
authors.forename: J N
authors.initials: JN
authors.lastname: Payne
authors.forename: P C
authors.initials: PC
authors.lastname: Milner
authors.forename: C
authors.initials: C
authors.lastname: Saul
authors.forename: I R
authors.initials: IR
authors.lastname: Bowns
authors.forename: D R
authors.initials: DR
authors.lastname: Hannay
authors.forename: L E
authors.initials: LE
authors.lastname: Ramsay
mesh_terms: D000368:Aged; D002423:Cause of Death; D002561:Cerebrovascular Disorders / Q000401:mortality*; D004739:England / Q000453:epidemiology; D005194:Family Practice; D006801:Humans; D006973:Hypertension / Q000401:mortality* / Q000628:therapy; D008485:Medical Audit; D008875:Middle Aged; D015588:Observer Variation; D011787:Quality of Health Care; D012307:Risk Factors