From the Clinical and Health Services Studies Unit, King's College
School of Medicine and Dentistry, London, UK.
Correspondence to Dr L. Kalra, Clinical and Health Services Studies Unit, King's College School of Medicine and Dentistry, Orpington Hospital, Sevenoaks Rd, Orpington BR6 9JU, UK.
Background—Research shows that
identification and control of risk factors reduces ischemic
stroke. The impact of this evidence and health initiatives on
mainstream practice remains unknown.
Methods—The purpose of this observational study was to
investigate prior management of risk factors (hypertension, atrial
fibrillation, previous stroke/transient ischemic attacks) in
patients with acute cerebral infarction. Data were collected on the
frequency of known risk factors before the incident stroke and their
management compared with predefined criteria for appropriateness. The
proportion of patients receiving treatment for risk factors before the
acute episode was studied over 3 years.
Results—One thousand seventy-four patients (median age, 76 years;
60% women) were included in the study over 3 years. The proportion of
patients with known hypertension (41% to 46%), diabetes (12% to
13%), previous stroke or transient ischemic attack (TIA) (21%
to 31%), and atrial fibrillation (16% to 21%) remained stable.
Overall, approximately 45% patients with atrial fibrillation, 60%
patients with hypertension, and 70% with cerebrovascular disease were
being actively managed. Time trends analysis showed a
significant increase in the proportion of patients being treated for
risk due to known cerebrovascular disease (59% to 85%), atrial
fibrillation (18% to 59%), ischemic heart disease (35% to
72%), and carotid disease (13% to 85%) between the first and third
year. The proportion of patients receiving treatment for hypertension
remained unchanged. Patients with preexisting symptomatic
vascular disease were more likely to receive appropriate risk
management compared with asymptomatic patients (72% versus
46%, P<.001).
Conclusions—Although a significant number of ischemic
events remain potentially preventable, there appears to be a positive
trend in improved control of stroke risk.
© 1998 American Heart Association, Inc.
Original Contributions
Stroke Risk Management
Changes in Mainstream Practice
Key Words: stroke prevention • risk factors • cerebral infarction
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