Clinical and Demographic Characteristics Associated With Suboptimal Primary Stroke and Transient Ischemic Attack Prevention: Retrospective Analysis
| Autor: | Ronan Ryan, Max G. Feltham, Tom Marshall, Grace M Turner, Samuel Finnikin, Melanie Calvert |
|---|---|
| Rok vydání: | 2017 |
| Předmět: |
Male
medicine.medical_specialty Primary health care Coronary Disease 030204 cardiovascular system & hematology Brain Ischemia 03 medical and health sciences Peripheral Arterial Disease 0302 clinical medicine Attack prevention Retrospective analysis medicine Humans Transient (computer programming) 030212 general & internal medicine Renal Insufficiency Chronic Stroke Antihypertensive Agents Aged Advanced and Specialized Nursing Aged 80 and over business.industry Anticoagulants Atrial fibrillation Middle Aged medicine.disease Emergency medicine Female Neurology (clinical) Cardiology and Cardiovascular Medicine business |
| Zdroj: | Stroke. 49(3) |
| ISSN: | 1524-4628 |
| Popis: | Background and Purpose— Primary prevention of stroke and transient ischemic attack (TIA) is important to reduce the burden of these conditions; however, prescribing of prevention drugs is suboptimal. We aimed to identify individual clinical and demographic characteristics associated with potential missed opportunities for prevention therapy with lipid-lowering, anticoagulant, or antihypertensive drugs before stroke/TIA. Methods— We analyzed anonymized electronic primary care records from a UK primary care database that covers 561 family practices. Patients with first-ever stroke/TIA, ≥18 years, with diagnosis between January 1, 2009, and December 31, 2013, were included. Missed opportunities for prevention were defined as people with clinical indications for lipid-lowering, anticoagulant, or antihypertensive drugs but not prescribed these drugs before their stroke/TIA. Mixed-effect logistic regression models evaluated the relationship between missed opportunities and individual clinical/demographic characteristics. Results— The inclusion criteria were met by 29 043 people with stroke/TIA. Patients with coronary heart disease, chronic kidney disease, peripheral arterial disease, or diabetes mellitus were at less risk of a missed opportunity for prescription of lipid-lowering and antihypertensive drugs. However, patients with a 10-year cardiovascular disease risk ≥20% but without these diagnoses had increased risk of having a missed opportunity for prescription of lipid-lowering drugs or antihypertensive drugs. Women were less likely to be prescribed anticoagulants but more likely to be prescribed antihypertensive drugs. The elderly (≥85 years of age) were less likely to be prescribed all 3 prevention drugs, compared with people aged 75 to 79 years. Conclusions— Knowing the patient characteristics predictive of missed opportunities for stroke prevention may help primary care identify and appropriately manage these patients. Improving the management of these groups may reduce their risk and potentially prevent large number of future strokes and TIAs in the population. |
| Databáze: | OpenAIRE |
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