title: Practice variation in long-term secondary stroke prevention in The Netherlands.
abstract: BACKGROUND
  Stroke guidelines emphasize the importance of adequate vascular risk factor assessment and management in transient ischemic attack (TIA) and ischemic stroke patients, but it is not clear how these guidelines are applied in routine clinical practice. The limited data that are available indicate that TIA and ischemic stroke patients often do not receive the recommended interventions. The aim of this study was to investigate practice variations in long-term secondary stroke prevention in The Netherlands.
  
  
  METHODS
  Between June and December 2013, an invitation for a web-based survey was sent to 90 Dutch neurologists with a special interest in stroke neurology. This web-based survey contained questions regarding the organization of outpatient care for TIA and ischemic stroke patients after initial hospital assessment, pharmacologic treatment, and nonpharmacologic strategies for long-term secondary prevention.
  
  
  RESULTS
  In total, 84 (93%) neurologists completed the survey. Although nearly all respondents reported that they follow-up TIA and ischemic stroke patients after initial hospital assessment, the number of follow-up visits and the follow-up duration were variable. A similar variation was found in treatment targets levels for both blood pressure and low-density lipoprotein cholesterol. Regarding nonpharmacologic strategies for long-term secondary stroke prevention, most respondents inform their TIA and ischemic stroke patients about the importance of smoking cessation. There is considerably less attention for the other lifestyle risk factors.
  
  
  CONCLUSIONS
  We found considerable practice variation in long-term secondary stroke prevention. These variations may have an impact on the risk for stroke recurrence and cardiovascular disease in general.
authors.affiliation: Department of Neurology, Sint Lucas Andreas Ziekenhuis, Amsterdam, The Netherlands. Electronic address: svschaik@gmail.com.
authors.forename: Sander M
authors.initials: SM
authors.lastname: van Schaik
authors.affiliation: Department of Neurology, Sint Lucas Andreas Ziekenhuis, Amsterdam, The Netherlands.
authors.forename: Blanche S
authors.initials: BS
authors.lastname: de Vries
authors.affiliation: Department of Neurology, Sint Lucas Andreas Ziekenhuis, Amsterdam, The Netherlands.
authors.forename: Henry C
authors.initials: HC
authors.lastname: Weinstein
authors.affiliation: Department of Neurology, VU medical center, Amsterdam, The Netherlands.
authors.forename: Marieke C
authors.initials: MC
authors.lastname: Visser
authors.affiliation: Department of Neurology, Sint Lucas Andreas Ziekenhuis, Amsterdam, The Netherlands.
authors.forename: Renske M
authors.initials: RM
authors.lastname: Van den Berg-Vos
mesh_terms: D000924:Anticholesteremic Agents / Q000627:therapeutic use; D000959:Antihypertensive Agents / Q000627:therapeutic use; D019983:Guideline Adherence / Q000639:trends; D019538:Health Care Surveys; D006801:Humans; D020407:Internet; D002546:Ischemic Attack, Transient / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*; D008134:Long-Term Care / Q000639:trends*; D009426:Netherlands; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000639:trends*; D011787:Quality of Health Care / Q000639:trends; D012008:Recurrence; D018570:Risk Assessment; D012307:Risk Factors; D040242:Risk Reduction Behavior; D055502:Secondary Prevention / Q000639:trends*; D016540:Smoking Cessation; D020521:Stroke / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*; D011795:Surveys and Questionnaires; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000924:Anticholesteremic Agents; D000959:Antihypertensive Agents
keywords: Stroke; life style; quality of health care; secondary prevention; transient ischemic attack