title: How do general practitioners manage patients at risk from stroke?
abstract: This study assessed by means of a postal questionnaire how general practitioners (GPs) manage patients at risk from stroke. Of the 640 GPs sent a questionnaire, 294 (46%) replied. In patients with a recent transient ischaemic attack or minor ischaemic stroke, 24% of responding GPs would not arrange any investigations. Sixty-one per cent refer under half of their patients for further investigation, although 99% of GPs would commence aspirin. Seventy-seven per cent of GPs were aware of the benefits of carotid surgery. For patients in atrial fibrillation, most GPs (77%) thought that warfarin reduced stroke rates, but only 20% would consider commencing warfarin, although 26% would commence aspirin. In hypertensive patients, the GPs' threshold for treatment ranged from 135 to 200mmHg systolic (median 160mmHg), and from 90 to 110mmHg diastolic (median 100mmHg). Most GPs (84%) would treat isolated systolic hypertension with a median threshold of 180mmHg (range 140-240mmHg). The results of this study suggest that some patients at risk from stroke may not receive optimal investigation and treatment in the community.
authors.affiliation: Department of Medicine, Eastern General Hospital, Edinburgh.
authors.forename: G E
authors.initials: GE
authors.lastname: Mead
authors.forename: H
authors.initials: H
authors.lastname: Murray
authors.forename: C N
authors.initials: CN
authors.lastname: McCollum
authors.forename: P A
authors.initials: PA
authors.lastname: O'Neill
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000627:therapeutic use; D002561:Cerebrovascular Disorders / Q000517:prevention & control*; D005194:Family Practice; D006801:Humans; D006973:Hypertension / Q000188:drug therapy; D008875:Middle Aged; D010818:Practice Patterns, Physicians'; D012017:Referral and Consultation
chemical_list: D000925:Anticoagulants