This Article Full Text Full Text (PDF) All Versions of this Article: 39/6/1834    most recent STROKEAHA.107.503094v1 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 Google Scholar Articles by Touzé, E. Articles by Mas, J.-L. PubMed PubMed Citation Articles by Touzé, E. Articles by Mas, J.-L. Pubmed/NCBI databases Substance via MeSH Medline Plus Health Information High Blood Pressure Stroke Related Collections Health policy and outcome research Secondary prevention Cerebrovascular disease/stroke Other Stroke Treatment - Medical

(Stroke. 2008;39:1834.)
© 2008 American Heart Association, Inc.

Original Contributions

Importance of In-Hospital Initiation of Therapies and Therapeutic Inertia in Secondary Stroke Prevention

IMplementation of Prevention After a Cerebrovascular evenT (IMPACT) Study

Emmanuel Touzé, MD, PhD; Joël Coste, MD, PhD; Magdalena Voicu, MD; Jamal Kansao, MD; Rafik Masmoudi, MD; Benoît Doumenc, MD; Pierre Durieux, MD, PhD Jean-Louis Mas, MD

From the Department of Neurology (E.T., M.V., J.L.M.), Université Paris-Descartes, EA 4055 UMR 894, Centre Hospitalier Sainte-Anne, Paris, France; the Departments of Biostatistics (J.C.) and Emergencies (J.K.), APHP, Hôpital Cochin, Paris, France; Hôpital Européen Georges Pompidou (R.M.), Paris, France; Hôpital Bicêtre (B.D.), Le Kremlin-Bicêtre, Paris, France; and the Department of Public Health (P.D.), APHP, Hôpital Européen Georges Pompidou, Paris, France.

Correspondence to Emmanuel Touzé, MD, PhD, Université Paris Descartes, EA 4055, Department of Neurology, Hôpital Sainte-Anne, 1 rue Cabanis, 75014 Paris, France. E-mail e.touze{at}ch-sainte-anne.fr

Background and Purpose— Many patients do not receive prevention consistent with recommendations after stroke, but the relative importance of patient- and physician-related factors is uncertain.

Methods— We prospectively assessed factors associated with blood pressure (BP) <140/90 mm Hg and low-density lipoprotein (LDL) cholesterol <1 g/L in a collaborative cohort of 240 consecutive patients experiencing stroke/transient ischemic attack (Rankin <4; 80 years; no major comorbidity) from a stroke unit and 3 emergency departments. A standardized assessment of risk factors was performed 6 and 12 months after the initial event by an investigator who was not involved in the usual follow-up of patients.

Results— At 6 months, 41% of patients with diagnosed hypertension at inclusion had their BP <140/90 mm Hg and 55% of those with diagnosed hypercholesterolemia had their LDL <1 g/L. Adherence to treatment was excellent in 81% of patients. In univariate and multivariate analyses, initiation or reinforcement of appropriate treatments during hospitalization were the main factors associated with BP <140/90 mm Hg (OR=2.44; 95% CI: 1.20 to 4.97) and LDL <1 g/L (OR=3.36; 1.27 to 8.89) or with decrease in BP and LDL. Patients’ sociodemographic characteristics, education, income, knowledge of disease, and risk factors were not associated with control of BP or LDL. Among patients with BP 140/90 mm Hg, approximately 40% received either no treatment or one drug only, and treatment was reinforced in 20% of them only. Results were similar at 12 months with no improvement in the rate of control of risk factors.

Conclusion— Therapeutic inertia is an important impediment to achieve BP and LDL control goals after stroke, even in fairly motivated/adherent patients. In-hospital initiation of preventive therapies could improve quality of secondary stroke prevention in the long term.

Key Words: adherence • guidelines • hypertension • secondary prevention • stroke