Risk factors and treatment at recurrent stroke onset: results from the Recurrent Stroke Quality and Epidemiology (RESQUE) Study.
BACKGROUND
Much effort has been made to study first-ever stroke patients. However, recurrent stroke has not been investigated as extensively. It is unclear which risk factors dominate, and whether adequate secondary prevention has been provided to patients who suffer from recurrent stroke. Also, the different types of recurrent stroke need further evaluation.


METHODS
The study included patients with recurrent stroke admitted to twenty-three Swedish stroke centers. The type of previous and recurrent stroke was determined, as well as evaluation (when applicable) of recurrent ischemic stroke according to the TOAST classification. Presence of vascular risk factors was registered and compared to the type of stroke. Also assessed was ongoing secondary prevention treatment at recurrent stroke onset.


RESULTS
A total of 889 patients with recurrent stroke (mean age 77) were included in the study. Of these, 805 (91%) had ischemic stroke, 78 (9%) had intracerebral hemorrhage and 6 (<1%) stroke of unknown origin. The most frequent vascular risk factors were hypertension (75%) and hyperlipidemia (56%). Among the 889 patients, 29% had atrial fibrillation. Of the patients in the ischemic group with cardiac embolism, only 21% were on anticoagulation treatment. The majority of the patients (75%) had their most recent previous stroke >12 months before admission.


CONCLUSIONS
Few patients had a recurrent stroke shortly after the previous stroke in this study. This indicates that it is meaningful to prevent a second event with an adequate long-term treatment strategy for secondary prevention after first-ever stroke. There also seems to be a clear potential for improving secondary prevention after stroke.
Leoo
T
T
Department of Clinical Pharmacology, Sahlgrenska University, Goteborg, Sweden.
Lindgren
A
A
Petersson
J
J
von Arbin
M
M
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000627:therapeutic use; D000959:Antihypertensive Agents / Q000627:therapeutic use; D001281:Atrial Fibrillation / Q000150:complications / Q000188:drug therapy; D002545:Brain Ischemia / Q000150:complications* / Q000188:drug therapy / Q000453:epidemiology / Q000209:etiology; D002317:Cardiovascular Agents / Q000627:therapeutic use*; D002543:Cerebral Hemorrhage / Q000150:complications* / Q000188:drug therapy / Q000453:epidemiology / Q000209:etiology; D048909:Diabetes Complications / Q000188:drug therapy / Q000209:etiology; D004617:Embolism / Q000150:complications / Q000188:drug therapy; D005260:Female; D006801:Humans; D006949:Hyperlipidemias / Q000150:complications / Q000188:drug therapy; D006973:Hypertension / Q000150:complications / Q000188:drug therapy; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D012042:Registries; D018570:Risk Assessment; D012307:Risk Factors; D055502:Secondary Prevention; D012907:Smoking / Q000009:adverse effects; D020521:Stroke / Q000188:drug therapy* / Q000453:epidemiology / Q000209:etiology* / Q000517:prevention & control; D013548:Sweden / Q000453:epidemiology; D013997:Time Factors; D016896:Treatment Outcome
D000925:Anticoagulants; D000959:Antihypertensive Agents; D002317:Cardiovascular Agents; D010975:Platelet Aggregation Inhibitors