title: Discontinuation of secondary preventive treatment of stroke: an unexplored scenario in India.
abstract: OBJECTIVE
  This prospective study will evaluate the socioeconomic factors responsible for the discontinuation of secondary preventive treatment of stroke in India and its outcome. DESIGNS METHODS: A total of 1212 stroke patients (male=708, mean age 58 ± 2 years; female=504, mean age 56 ± 2 years; intra-cerebral haemorrhage=496; ischaemic=716) were enrolled in the stroke clinic for secondary preventive treatment from 1st January 2006 to 1st January 2008 and were followed up at 4-6-week intervals. Among them, 512 patients were grouped as being below the poverty line. Discontinuation of treatment for more than 2 weeks by a patient placed that patient in a group labelled discontinued. Outcomes of discontinuation of secondary preventive treatment were evaluated with respect to (1) control of risk factors, (2) recurrence of stroke, and (3) mortality rate. Reasons for the discontinuation were comparatively analysed with respect to awareness, education, economy, distance, and daily cost of treatment, types of stroke and disability status.
  
  
  RESULTS
  During the study period of 2 years, the following was observed: 420 patients (34.65%) discontinued secondary preventive treatment; 112 patients (9.24%) dropped out; 680 patients (56.10%) continued. Chi-square and null hypothesis procedures were applied for statistical analysis. Distance, economy, poor awareness on stroke, low educational level, types of stroke, cost of treatment and disability status all were significant factors in the discontinuation of treatment. The discontinued group had poor control of risk factors, higher recurrence of both types of stroke and higher mortality.
  
  
  CONCLUSIONS
  Discontinuation of secondary preventive treatment due to diverse socioeconomic factors results in greater recurrence and disabilities among stroke survivors, and these findings should be reported to national and international planning authorities to strengthen preventive measures to achieve better outcomes and reductions of the stroke burden globally.
authors.affiliation: Neurology Department, Burdwan Medical College & Hospital, Burdwan, West Bengal 713101, India. drkamaleshdas@rediffmail.com
authors.forename: Kamalesh
authors.initials: K
authors.lastname: Das
authors.forename: Mrinalkanti
authors.initials: M
authors.lastname: Ghosh
authors.forename: Bidisha
authors.initials: B
authors.lastname: Khanna
authors.forename: Mausumi
authors.initials: M
authors.lastname: Banerjee
authors.forename: G P
authors.initials: GP
authors.lastname: Mondal
authors.forename: Om Prakash
authors.initials: OP
authors.lastname: Singh
authors.forename: Arindam
authors.initials: A
authors.lastname: Chakraborty
mesh_terms: D000368:Aged; D017281:Cost of Illness; D004185:Disability Evaluation; D004522:Educational Status; D005260:Female; D006297:Health Services Accessibility / Q000191:economics / Q000706:statistics & numerical data; D006801:Humans; D007194:India / Q000453:epidemiology; D008019:Life Style; D008297:Male; D008875:Middle Aged; D011203:Poverty; D011446:Prospective Studies; D012307:Risk Factors; D055502:Secondary Prevention; D012959:Socioeconomic Factors; D020521:Stroke / Q000191:economics / Q000453:epidemiology / Q000517:prevention & control*; D017741:Survivors; D016896:Treatment Outcome