PROTECT: a coordinated stroke treatment program to prevent recurrent thromboembolic events.
OBJECTIVE
To assess the impact of the Preventing Recurrence of Thromboembolic Events through Coordinated Treatment (PROTECT) Program on achievement of its eight secondary prevention goals at the time of discharge.


METHODS
Achievement rates for the eight program goals at time of discharge were compared in all patients discharged from a university hospital-based stroke service with a diagnosis of ischemic stroke or TIA during a 1-year period after implementation of the PROTECT Program vs rates obtained from a comparable group of patients admitted to the same service during the preceding year.


RESULTS
Demographic and medical features were comparable in the baseline and intervention cohorts for all patients with cerebral ischemia presumed due to large-vessel atherosclerosis or small-vessel disease (baseline year n = 117, intervention n = 130). Implementation rates in patients without specific contraindications increased for all four medication goals: 97 to 100% for antithrombotic agents, 68 to 97% for statins, 42 to 90% for angiotensin-converting enzyme inhibitors/angiotensin receptor blockers, and 14 to 70% for diuretics. Although data were not collected on baseline lifestyle instruction rates, instruction in the program's four lifestyle interventions was achieved by discharge in 100% of the intervention cohort.


CONCLUSIONS
Implementation of this single-center, systems-based, in-hospital program to initiate secondary stroke prevention therapies was associated with a substantial increase in treatment utilization at the time of hospital discharge.
Stroke Center and Department of Neurology, UCLA Medical Center, Los Angeles, CA, USA. Ovibes@mednet.ucla.edu
B
B
Ovbiagele
J L
JL
Saver
A
A
Fredieu
S
S
Suzuki
N
N
McNair
A
A
Dandekar
T
T
Razinia
C S
CS
Kidwell
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000959:Antihypertensive Agents / Q000627:therapeutic use; D001521:Behavior Therapy; D002545:Brain Ischemia / Q000628:therapy; D002561:Cerebrovascular Disorders / Q000517:prevention & control*; D003131:Combined Modality Therapy; D005240:Feasibility Studies; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D015438:Health Behavior; D006784:Hospitals, Teaching; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use; D002537:Intracranial Arteriosclerosis / Q000628:therapy; D008297:Male; D008875:Middle Aged; D010353:Patient Education as Topic; D010865:Pilot Projects; D012008:Recurrence; D020521:Stroke / Q000628:therapy*; D013923:Thromboembolism / Q000517:prevention & control*
D000959:Antihypertensive Agents; D005343:Fibrinolytic Agents; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors