This Article Full Text Full Text (PDF) All Versions of this Article: 34/4/1010    most recent 01.STR.0000062888.90293.AAv1 Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Filippi, A. Articles by Mazzaglia, G. Search for Related Content PubMed PubMed Citation Articles by Filippi, A. Articles by Mazzaglia, G. Pubmed/NCBI databases Medline Plus Health Information Stroke Related Collections Anticoagulants Other Stroke Treatment - Medical Epidemiology Cerebrovascular disease/stroke Secondary prevention

(Stroke. 2003;34:1010.)
© 2003 American Heart Association, Inc.

Original Contributions

Secondary Prevention of Stroke in Italy

A Cross-Sectional Survey in Family Practice

Alessandro Filippi, MD; Angelo Antonio Bignamini, PhD; Emiliano Sessa; Fabio Samani, MD Giampiero Mazzaglia, MD, PhD, MSc

From the Italian College of General Practitioners (A.F., F.S.) and Health Search Database (E.S., G.M.), Florence, and School of Pharmacy (A.A.B.), University of Milan, Italy.

Correspondence and reprint requests to Emiliano Sessa, Health Search Database, Largo Cesare Cantù 8, 50143, Florence, Italy. E-mail sessa.emiliano{at}simg.it

Background— Hypertension control and antiplatelet or oral anticoagulant drugs are the basis for secondary prevention of cerebrovascular events. Family physicians (FPs) are usually involved in both aspects of prevention, but no research has been carried out in Italy to evaluate the behavior of FPs in this field of prevention.

Methods— Data concerning 318 Italian FPs and 465 061 patients were extracted from the Health Search Database. Patients with coded diagnoses of stroke and transient ischemic attack (TIA) were selected. Demographic records and information regarding presence of concurrent disease and medical records were also obtained. Logistic regression analyses were carried out to assess whether conditions exist that make appropriate control of blood pressure (BP) and prescription of antiplatelet or anticoagulant drugs more likely.

Results— We selected 2555 patients with diagnosis of stroke and 2755 with TIA. Among all of the subjects, 32.6% had no BP recorded. Among the remaining subjects, 58.7% reported uncontrolled BP. Isolated systolic hypertension has been shown in 68.8% of patients with uncontrolled BP. Antiplatelet and anticoagulant drugs were prescribed in 72% of these cases. Factors that made the prescription significantly more unlikely were diagnosis of TIA (odds ratio [OR], 0.47; 95% confidence interval [CI], 0.41 to 0.54), total invalidity (OR, 0.66; 95% CI 0.56 to 0.78), and time from event of 5 years or more (OR, 0.81; 95% CI, 0.70 to 0.94).

Conclusions— Italian FPs could improve secondary prevention of cerebrovascular accidents. The primary target of intervention should be the control of systolic BP, and the group of patients with unacceptably high BP should be given priority. All of these patients should have been prescribed antiplatelet drugs or anticoagulant agents, except in cases of extremely short life expectancy or substantial contraindications.

Key Words: cerebrovascular accident • family practice • prevention

This article has been cited by other articles:

				E. Touze, J. Coste, M. Voicu, J. Kansao, R. Masmoudi, B. Doumenc, P. Durieux, and J.-L. Mas Importance of In-Hospital Initiation of Therapies and Therapeutic Inertia in Secondary Stroke Prevention: IMplementation of Prevention After a Cerebrovascular evenT (IMPACT) Study Stroke, June 1, 2008; 39(6): 1834 - 1843. [Abstract] [Full Text] [PDF]

				E. Sacchetti, G. Trifiro, A. Caputi, C. Turrina, E. Spina, C. Cricelli, O. Brignoli, E. Sessa, and G. Mazzaglia Risk of stroke with typical and atypical anti-psychotics: a retrospective cohort study including unexposed subjects J Psychopharmacol, January 1, 2008; 22(1): 39 - 46. [Abstract] [PDF]

				D. A. Levine, C. I. Kiefe, T. K. Houston, J. J. Allison, E. P. McCarthy, and J. Z. Ayanian Younger Stroke Survivors Have Reduced Access to Physician Care and Medications: National Health Interview Survey From Years 1998 to 2002 Arch Neurol, January 1, 2007; 64(1): 37 - 42. [Abstract] [Full Text] [PDF]

				L. Galatti, A. Sessa, G. Mazzaglia, S. Pecchioli, A. Rossi, C. Cricelli, G. C. Schito, G. Nicoletti, and A. P. Caputi Antibiotic prescribing for acute and recurrent cystitis in primary care: a 4 year descriptive study J. Antimicrob. Chemother., March 1, 2006; 57(3): 551 - 556. [Abstract] [Full Text] [PDF]

				S. Volpato, C. Maraldi, A. Ble, M. Ranzini, A. Rita Atti, L. J. Dominguez, M. Barbagallo, R. Fellin, and G. Zuliani Prescription of Antithrombotic Therapy in Older Patients Hospitalized for Transient Ischemic Attack and Ischemic Stroke: The GIFA Study Stroke, April 1, 2004; 35(4): 913 - 917. [Abstract] [Full Text] [PDF]