Secondary prevention after ischaemic stroke: the ASPIRE-S study.
BACKGROUND
Survivors of ischaemic stroke (IS) are at high-risk for future vascular events. Comprehensive information on the adequacy of secondary prevention after IS is lacking despite the knowledge that appropriate secondary prevention improves long-term patient outcomes. ASPIRE-S (Action on Secondary Prevention Interventions and Rehabilitation in Stroke) aimed to prospectively assess secondary prevention in patients 6 months following IS.


METHODS
Consenting patients admitted with IS to three Dublin hospitals were recruited over 1 year, from October 2011. At 6 months post IS a comprehensive assessment was completed, modelled on the EUROASPIRE protocol for evaluation of the adequacy of secondary prevention in post-discharge cardiac patients. This assessment included measurements of blood pressure, body mass index and fasting lipid and glucose profiles. Secondary preventive medications and smoking status were also documented.


RESULTS
Three hundred two patients (58 % male) participated, of whom 256 (85 %) were followed-up at 6 months. Mean age was 69 years (range 22-95). At follow-up, 68 % of patients had a BMI >25 kg/m(2) and 16.4 % were still smoking. Almost two-thirds (63.4 %) had a blood pressure >140/90 and 23 % had low-density-lipoprotein >2.5 mmol/L. 28 % of diabetic patients had HbA1c ≥ 7 %. Ninety seven percent of patients were on anti-platelet and/or anticoagulant therapy. Of those with atrial fibrillation, 82 % were anti-coagulated (mean INR of 2.4). Ninety-five percent were on lipid-lowering therapy and three-quarters were on anti-hypertensive therapy.


CONCLUSIONS
This prospective multi-centre survey of IS patients demonstrated a high prevalence of remaining modifiable risk factors at 6 months post stroke, despite the widespread prescription of secondary preventive medications. There is scope to improve preventive measures after IS (in particular blood pressure) by incorporating evidence-based guidelines into quality assurance cycles in stroke care.
Department of Geriatric & Stroke Medicine, Royal College of Surgeons in Ireland (RCSI), Beaumont Hospital, Dublin, 9, Ireland. lindabrewer@beaumont.ie.
Linda
L
Brewer
Department of Psychology, RCSI, Dublin, 2, Ireland. lisamellon@rcsi.ie.
Lisa
L
Mellon
Department of Psychology, RCSI, Dublin, 2, Ireland. phalger@outlook.com.
Patricia
P
Hall
Department of Geriatric & Stroke Medicine, Connolly Hospital, Blanchardstown, Dublin, 15, Ireland. eamon028@indigo.ie.
Eamon
E
Dolan
School of Physiotherapy, RCSI, Dublin, 2, Ireland. fhorgan@rcsi.ie.
Frances
F
Horgan
Department of Epidemiology and Public Health, RCSI, Dublin, 2, Ireland. emershelley@rcsi.ie.
Emer
E
Shelley
Department of Psychology, RCSI, Dublin, 2, Ireland. ahickey@rcsi.ie.
Anne
A
Hickey
Department of Geriatric & Stroke Medicine, Royal College of Surgeons in Ireland (RCSI), Beaumont Hospital, Dublin, 9, Ireland. davidwilliams@rcsi.ie.
David
D
Williams
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002545:Brain Ischemia / Q000517:prevention & control*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care / Q000379:methods*; D012307:Risk Factors; D055502:Secondary Prevention / Q000379:methods*; D020521:Stroke / Q000517:prevention & control*; D055815:Young Adult