Stroke risk management: changes in mainstream practice.
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.
Kalra
L
L
Clinical and Health Services Studies Unit, King's College School of Medicine and Dentistry, London, UK.
Perez
I
I
Melbourn
A
A
D000208:Acute Disease; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001281:Atrial Fibrillation / Q000517:prevention & control / Q000628:therapy; D002545:Brain Ischemia / Q000517:prevention & control; D002340:Carotid Artery Diseases / Q000517:prevention & control / Q000628:therapy; D002544:Cerebral Infarction / Q000517:prevention & control / Q000628:therapy; D002561:Cerebrovascular Disorders / Q000517:prevention & control* / Q000628:therapy; D003920:Diabetes Mellitus / Q000517:prevention & control / Q000628:therapy; D005260:Female; D005500:Follow-Up Studies; D006293:Health Promotion; D006801:Humans; D006973:Hypertension / Q000517:prevention & control / Q000628:therapy; D002546:Ischemic Attack, Transient / Q000517:prevention & control / Q000628:therapy; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000517:prevention & control / Q000628:therapy; D016491:Peripheral Vascular Diseases / Q000517:prevention & control / Q000628:therapy; D012307:Risk Factors; D012907:Smoking / Q000628:therapy; D000074606:Smoking Prevention; D014652:Vascular Diseases / Q000517:prevention & control / Q000628:therapy