The impact of a stroke prevention clinic in diagnosing modifiable risk factors for stroke.
OBJECTIVE
To evaluate the referral patterns of patients to a stroke prevention clinic (SPC) and to test the adequacy of prereferral diagnosis and management of modifiable risk factors for stroke.


METHODS
We collected prospective data on consecutive patients referred to the SPC at University of Alberta Hospital in Edmonton, Alberta, Canada. Outcome measures included: alternate diagnoses to stroke or transient ischemic attack (TIA), uncontrolled or undiagnosed hypertension, hyperlipidemia and diabetes, therapies, and investigations leading to carotid endarterectomy.


RESULTS
Two thousand and eleven patients were referred to SPC. Nearly 25% of the referrals originated from the emergency room and the rest from general physicians. Of the referrals, 68.7% were confirmed as TIA or stroke at the SPC. Among 1381 patients with TIA or stroke, 736 had history of hypertension. Uncontrolled hypertension was found in 265 patients (36.0% of those with hypertension: 95% CI: 32.5-39.5) while undiagnosed hypertension was found in 103 (15.9% of those without hypertension: 95%CI: 13.14-18.79). History of hyperlipidemia was present in 451 patients (32.6%) and 356 (78.9%: 95% CI: 75.2-82.69) of these patients were not at target for secondary prevention. Among 930 patients without history of hyperlipidemia, 739 (79.5%: 95% CI: 76.8-82.1) were diagnosed with hyperlipidemia through the SPC. Fasting blood glucose levels above 7.1 mmol/L in patients with and without history of diabetes were 221 (79.2%: 95% CI: 74.5-83.9) and 66 (6%: 95%CI: 4.6-7.4) respectively.


CONCLUSIONS
Management of risk factors for stroke needs improvement. SPCs should consider actively managing the classical modifiable risk factors of stroke.
Mouradian
Mikael S
MS
Division of Neurology, University of Alberta, Edmonton, AB, Canada.
Hussain
Muhammad S
MS
Lari
Harris
H
Salam
Abdul
A
Senthilselvan
Ambikaipakan
A
Dean
Naeem
N
Shuaib
Ashfaq
A
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000554:Ambulatory Care Facilities; D005260:Female; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000175:diagnosis; D008297:Male; D008875:Middle Aged; D012017:Referral and Consultation; D012307:Risk Factors; D020521:Stroke / Q000175:diagnosis* / Q000209:etiology / Q000517:prevention & control*