title: Long-term adherence to national guidelines for secondary prevention of ischemic stroke: a prospective cohort study in a public hospital in Chile.
abstract: BACKGROUND
  Clinical guidelines for the secondary prevention of ischemic stroke have been developed, but their publication is insufficient to make them effective. Our aim was to investigate adherence to Chilean guidelines, its associated variables, and to determine prognosis at follow-up.
  
  
  METHODS
  We prospectively included all consecutive patients discharged with a diagnosis of ischemic stroke from Valparaíso Regional Hospital between July 15, 2007 and January 15, 2008. Patient follow-up was performed at 5, 10, and 15 months using a standardized questionnaire. We used the Chi-square and Fisher exact tests to compare discrete variables and multivariate logistic regression analysis to adjust for potential confounding factors. A Cox regression model was fitted.
  
  
  RESULTS
  We included 156 patients; 128 patients (82%) completed follow-up. Adherence to oral anticoagulation decreased significantly compared to all other medications during follow-up (P = .004). This was not associated with any of the studied variables. Adherence to antihypertensives, statins, and hypoglycemic medications remained >65% without a significant variation. Patients with cardioembolic stroke had greater mortality (P = .003) and recurrence rates.
  
  
  CONCLUSIONS
  The observed significant decrease in adherence to oral anticoagulation in patients with cardioembolic stroke suggests a need for the implementation of specific strategies to achieve the desired secondary prevention goals in these patients. Future research into the evaluation of other factors that could be associated with the lack of adherence to these guidelines, measurements of therapeutic goals, and new therapeutic strategies that are easier to use and that are associated with less risk could improve the prognosis of these patients.
authors.affiliation: Vascular Neurology Program Neurology Service, Department of Medicine, Clínica Alemana de Santiago, Universidad del Desarrollo, Santiago, Chile. Electronic address: pmventurelli@gmail.com.
authors.forename: Paula
authors.initials: P
authors.lastname: Muñoz-Venturelli
authors.affiliation: Neurology Program, Department of Medicine, Universidad de Valparaíso, Valparaíso, Chile.
authors.forename: Claudio
authors.initials: C
authors.lastname: Sacks
authors.affiliation: Centro de investigaciones Biomédicas, Departamento de Ciencias Biomédicas, Universidad de Valparaíso.
authors.forename: Eva
authors.initials: E
authors.lastname: Madrid
authors.affiliation: Vascular Neurology Program Neurology Service, Department of Medicine, Clínica Alemana de Santiago, Universidad del Desarrollo, Santiago, Chile; Universidad del Desarrollo, Santiago and Department of Neurological Sciences, School of Medicine, Universidad de Chile.
authors.forename: Pablo M
authors.initials: PM
authors.lastname: Lavados
mesh_terms: D000284:Administration, Oral; D000328:Adult; D000925:Anticoagulants / Q000008:administration & dosage*; D002545:Brain Ischemia / Q000175:diagnosis / Q000401:mortality / Q000517:prevention & control*; D016009:Chi-Square Distribution; D002677:Chile; D005260:Female; D019983:Guideline Adherence / Q000592:standards*; D019538:Health Care Surveys; D006779:Hospitals, Public; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D017410:Practice Guidelines as Topic / Q000592:standards*; D010818:Practice Patterns, Physicians' / Q000592:standards*; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012307:Risk Factors; D055502:Secondary Prevention / Q000592:standards*; D020521:Stroke / Q000175:diagnosis / Q000401:mortality / Q000517:prevention & control*; D011795:Surveys and Questionnaires; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000925:Anticoagulants
keywords: Cerebrovascular disease; secondary prevention; stroke