title: Impact of Secondary Prevention on Mortality after a First Ischemic Stroke in Puerto Rico.
abstract: The objective of this study was to evaluate the impact of the prescription of secondary prevention therapies on mortality in Puerto Rican patients hospitalized with a first ischemic stroke.
  
  
  
  This was a retrospective secondary data analysis of the 2007 and 2009 Puerto Rico Stroke Registry electronic database. Information was obtained from the medical charts of patients discharged with ICD-9 codes 434 and 436 from 20 hospitals located in Puerto Rico. Descriptive analyses were conducted for demographics and comorbidities. Chi2 statistics compared the proportion of patients prescribed secondary prevention therapy and the proportion of patients not prescribed secondary prevention therapy. Lastly, survival rates were calculated from 2007 up to and including December 2010.
  
  
  
  The mean age of the 3,965 patients was 70 (±14) years. Secondary prevention therapy was prescribed to only 1% of the patients. The most frequent comorbidities were hypertension (85%), diabetes (52%), and hyperlipidemia (25%). The case fatality rate for patients prescribed secondary prevention therapy was 16%, compared to 26% for patients not prescribed secondary prevention therapy (p<0.01). The mean survival for stroke patients prescribed secondary preventions was 450 days (95% CI;182−718), compared to 266 days (95% CI; 244−287) for those not prescribed secondary prevention therapy (p = 0.175).
  
  
  
  A low percentage of patients with a first ischemic stroke were prescribed secondary prevention therapy. While not statistically significant, survival analysis suggests that secondary prevention therapy decreased mortality in patients with a stroke.
authors.affiliation: Adjunct Professor, School of Pharmacy, University of Puerto Rico Medical Sciences Campus, San Juan, PR.
authors.forename: Maria E
authors.initials: ME
authors.lastname: Rojas
authors.affiliation: Assistant Dean for Assessment and Accreditation, School of Pharmacy, University of New England, Portland, Maine, USA.
authors.forename: Wallace
authors.initials: W
authors.lastname: Marsh
authors.affiliation: Biostatistician, Division for Tobacco Control and Oral Health, Puerto Rico Department of Health, SanJuan, PR.
authors.forename: Marcos E
authors.initials: ME
authors.lastname: Felici-Giovanini
authors.affiliation: Assistant Professor, Department of General Social Sciences, University of Puerto Rico, Rio Piedras Campus, San Juan, PR.
authors.forename: Rosa J
authors.initials: RJ
authors.lastname: Rodríguez-Benitez
authors.affiliation: Associate Professor, FIU Herbert Wertheim College of Medicine, Biscayne Bay Campus, Miami, Florida, USA.
authors.forename: Juan C
authors.initials: JC
authors.lastname: Zevallos
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002545:Brain Ischemia / Q000401:mortality / Q000517:prevention & control*; D003920:Diabetes Mellitus / Q000453:epidemiology; D005260:Female; D006760:Hospitalization; D006801:Humans; D006949:Hyperlipidemias / Q000453:epidemiology; D006973:Hypertension / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D011647:Puerto Rico; D012042:Registries; D012189:Retrospective Studies; D055502:Secondary Prevention / Q000379:methods*; D020521:Stroke / Q000401:mortality / Q000517:prevention & control*; D016019:Survival Analysis; D015996:Survival Rate; D013997:Time Factors
keywords: Acute ischemic stroke; Cerebrovascular disease; First ischemic stroke; Mortality; Secondary prevention therapy