Tracking trends in secondary stroke prevention strategies.
BACKGROUND
Stroke is defined as a rapid onset of isolated neurologic dysfunction and is the leading cause of disability in adults, as well as the third-leading cause of death in the US. Nearly 600,000 cases of stroke are reported annually.


OBJECTIVE
To quantify the impact of emerging evidence on the use of secondary stroke prevention strategies in patients discharged from a specialized stroke center in 2002 compared with those discharged in 2000.


METHODS
Using a retrospective approach, data were collected on the first 100 patients cared for by the stroke service from July 1, 2000, to December 31, 2000. Using a prospective approach, the goal was to enroll 100 patients with a diagnosis of ischemic stroke and telephone the patients 1 and 3 months after discharge to determine patient adherence and persistence rate of medications. This is an interim report of the first 20 patients enrolled.


RESULTS
Both studies resulted in populations of 55% women and 45% men. The most common risk factor was hypertension, with 59% on admission in 2000 and 75% in 2002. Use of antithrombotics (98% in 2000 to 100% in 2002) and antihypertensives (67% in 2000 to 90% in 2002) was high in both studies and not significantly different. The 2 most significant changes in prescribing were increased use of statins (13% in 2000 to 50% in 2002, p = 0.0007) and combination clopidogrel and aspirin use (0% in 2000 to 20% in 2002, p = 0.001). At 3 months, 66.7% of patients were on the same antithrombotic medication as at discharge.


CONCLUSIONS
The dedicated stroke service was able to effectively translate emerging evidence and guidelines into practice and significantly change the use of prescribed medications for secondary stroke prevention.
Carswell
Jody L
JL
Medical College of Georgia Health, Augusta, GA, USA.
Beard
Kemberley A
KA
Chevrette
Michele M
MM
Pardue
Carol N
CN
Hess
David C
DC
Fagan
Susan C
SC
D000959:Antihypertensive Agents / Q000627:therapeutic use*; D002986:Clinical Trials as Topic; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use*; D006973:Hypertension / Q000150:complications / Q000188:drug therapy; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012189:Retrospective Studies; D012307:Risk Factors; D055502:Secondary Prevention; D020521:Stroke / Q000209:etiology / Q000517:prevention & control*
D000959:Antihypertensive Agents; D005343:Fibrinolytic Agents; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors