Secondary Prevention after Ischemic Stroke or Transient Ischemic Attack - 06/08/14
, Lee Schwamm, MD b, Eric E. Smith, MD, MPH c, Inder M. Singh, MD, MS d, Li Liang, PhD e, Gregg C. Fonarow, MD f, Deepak L. Bhatt, MD, MPH gfor the
Get With the Guidelines-Stroke Steering Committee and Investigators
Abstract |
Background |
Patients with stroke or transient ischemic attack are at increased risk of recurrent stroke. Transient ischemic attack is a harbinger for stroke merely hours to days after the initial transient ischemic attack. There is thus a narrow window of opportunity to initiate evidence-based therapies for secondary prevention of stroke. Our objective was to assess hospital adherence at discharge to secondary prevention measures after transient ischemic attack or ischemic stroke.
Methods |
Observational study of patients in the Get With The Guidelines-Stroke registry from 2007 to 2011. Patients were divided into 2 cohorts based on presentation: transient ischemic attack versus ischemic stroke. Adherence to evidence-based secondary prevention and other quality measures were assessed.
Results |
Among the 858,835 patients with transient ischemic attack or ischemic stroke, 259,319 (30%) patients presented with a transient ischemic attack and 599,516 (70%) patients presented with an ischemic stroke. After adjusting for patient and hospital characteristics, adherence to secondary prevention measures was consistently lower for the transient ischemic attack cohort (vs ischemic stroke cohort), who had lower odds of being discharged on antithrombotics (odds ratio [OR] 0.63; 95% confidence interval [CI], 0.59-0.66; P <.0001), anticoagulants for atrial fibrillation (OR 0.65; 95% CI, 0.61-0.68; P <.0001), lipid-lowering medication for LDL >100 mg/dL (OR 0.52; 95% CI, 0.50-0.54; P <.0001), intensive statin therapy (OR 0.74; 95% CI, 0.72-0.76; P <.0001), LDL cholesterol measurement (OR 0.66; 95% CI, 0.64-0.68; P <.0001), smoking cessation counseling (OR 0.83; 95% CI, 0.78-0.89; P <.0001), stroke education (OR 0.71; 95% CI, 0.69-0.73; P <.0001), or weight loss recommendations (OR 0.88; 95% CI, 0.85-0.90; P <.0001). The adherence to evidence-based therapies increased significantly (P <.0001) over time (2007-2011) for both the cohorts, but the increasing trend was consistently lower for patients who presented with transient ischemic attack.
Conclusions |
In patients surviving an ischemic stroke or transient ischemic attack, adherence to evidence-based secondary prevention discharge measures were consistently less for patients with transient ischemic attack, thus representing a missed opportunity at instituting preventive measures to reduce the risk of recurrent stroke.
El texto completo de este artículo está disponible en PDF.Keywords : Secondary prevention, Stroke, Transient ischemic attacks
Esquema
| Funding: The GWTG-Stroke program is provided by the AHA/American Stroke Association. The GWTG-Stroke program is currently supported in part by a charitable contribution from Janssen Pharmaceutical Companies of Johnson & Johnson. GWTG-Stroke has been funded in the past through support from Boehringer Ingelheim, Merck, Bristol-Myers Squib/Sanofi Pharmaceutical Partnership, and the AHA Pharmaceutical Roundtable. The industry sponsors of GWTG-Stroke had no role in the design and conduct of the study; in the collection, analysis, and interpretation of the data; or in the preparation, review, or approval of the manuscript. |
|
| Conflicts of Interest: SB, EES, IMS, and LL report no disclosures. LS reports the following: Serves as the unpaid chair of the AHA GWTG Stroke Clinical Working Group; serves as a Stroke Systems of Care Expert Consultant and measure development expert to the Joint Commission, Coverdell Registry/MA Dept of Public Health; is on the steering committee for the Medtronic Victory AF trial, and the DSMB for the NovoNordisk DEVOTE trial. He receives research funding from NINDS and PCORI. GCF reports the following: Employment—UCLA Employee, which holds a patent on stroke retriever devices National Institutes of Health—Grants and grants pending. DLB discloses the following relationships: Advisory Board, Elsevier; Practice Update Cardiology, Medscape Cardiology, Regado Biosciences; Board of Directors: Boston VA Research Institute, Society of Cardiovascular Patient Care; Chair: American Heart Association Get With The Guidelines Steering Committee; Data Monitoring Committees: Duke Clinical Research Institute; Harvard Clinical Research Institute; Mayo Clinic; Population Health Research Institute; Honoraria: American College of Cardiology (Editor, Clinical Trials, Cardiosource), Belvoir Publications (Editor in Chief, Harvard Heart Letter), Duke Clinical Research Institute (clinical trial steering committees), Harvard Clinical Research Institute (clinical trial steering committee), HMP Communications (Editor in Chief, Journal of Invasive Cardiology); Population Health Research Institute (clinical trial steering committee), Slack Publications (Chief Medical Editor, Cardiology Today’s Intervention), WebMD (CME steering committees); Other: Clinical Cardiology (Associate Editor); Journal of the American College of Cardiology (Section Editor, Pharmacology); Research Grants: Amarin, AstraZeneca, Bristol-Myers Squibb, Eisai, Ethicon, Medtronic, Roche, Sanofi Aventis, The Medicines Company; Unfunded Research: FlowCo, PLx Pharma, Takeda. |
|
| Authorship: All authors had access to the data and a role in writing the manuscript. |
Vol 127 - N° 8
P. 728-738 - août 2014 Regresar al número
Artículo precedente
- Obesity, Abdominal Obesity, Physical Activity, and Caloric Intake in US Adults: 1988 to 2010
- Uri Ladabaum, Ajitha Mannalithara, Parvathi A. Myer, Gurkirpal Singh
- A Prospective Study of Caffeine Intake and Risk of Incident Tinnitus
- Jordan T. Glicksman, Sharon G. Curhan, Gary C. Curhan
Bienvenido a EM-consulte, la referencia de los profesionales de la salud.
El acceso al texto completo de este artículo requiere una suscripción.
¿Ya suscrito a @@106933@@ revista ?