title: In-hospital initiation of secondary stroke prevention therapies yields high rates of adherence at follow-up.
abstract: OBJECTIVE
  The Stroke PROTECT (Preventing Recurrence Of Thromboembolic Events through Coordinated Treatment) program systematically implements, at the time of acute transient ischemic attack (TIA) or ischemic stroke admission, 8 medication/behavioral secondary prevention measures known to improve outcome in patients with cerebrovascular disease. The objective of this study was to determine if the high utilization rates previously demonstrated at hospital discharge were maintained at 90 days after discharge.
  
  
  METHODS
  Data were prospectively collected on consecutively encountered ischemic stroke and TIA patients admitted to a university hospital stroke service beginning September 1, 2002. PROTECT interventions were initiated before hospital discharge in all PROTECT-target (underlying stroke mechanism large vessel atherosclerosis or small vessel disease) and PROTECT-ACS (At-risk for Coronary Sequelae) patients. Adherence to program goals was assessed 3 months after discharge.
  
  
  RESULTS
  During the period from September 2002 to August 2003, 144 individuals met criteria for PROTECT intervention. Of the 130 patients (90%) with available day 90 follow-up data, mean age was 72 (range, 37 to 95), and 63% were male. Adherence rates in patients without specific contraindications were 100% for antithrombotics, 99% for statins, 92% for angiotensin-converting enzyme inhibitors/angiotensin receptor blockers, and 80% for thiazides. Awareness of the importance of calling 911 in response to stroke was 87%. Adherence to diet and exercise guidelines were 78% and 70%, respectively. Of the 24 smokers, tobacco cessation was maintained in 20 (83%).
  
  
  CONCLUSIONS
  High rates of adherence to PROTECT therapies were maintained at 90 days after hospital discharge.
authors.affiliation: Stroke Center and Department of Neurology, University of California at Los Angeles, 710 Westwood Plaza, Los Angeles, CA 90095, USA. Ovibes@mednet.ucla.edu.
authors.forename: Bruce
authors.initials: B
authors.lastname: Ovbiagele
authors.forename: Jeffrey L
authors.initials: JL
authors.lastname: Saver
authors.forename: Andre
authors.initials: A
authors.lastname: Fredieu
authors.forename: Shuichi
authors.initials: S
authors.lastname: Suzuki
authors.forename: Scott
authors.initials: S
authors.lastname: Selco
authors.forename: Venkatakrishna
authors.initials: V
authors.lastname: Rajajee
authors.forename: Norma
authors.initials: N
authors.lastname: McNair
authors.forename: Tannaz
authors.initials: T
authors.lastname: Razinia
authors.forename: Chelsea S
authors.initials: CS
authors.lastname: Kidwell
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006760:Hospitalization; D006801:Humans; D002546:Ischemic Attack, Transient / Q000517:prevention & control / Q000534:rehabilitation; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance; D010351:Patient Discharge; D015397:Program Evaluation; D020521:Stroke / Q000517:prevention & control*; D000071939:Stroke Rehabilitation