Abstract W P369: International Variability in Stroke Preventive Care
Introduction: Research protocols for stroke prevention trials commonly specify goals for preventive care. We report variability in goal achievement between 3 countries participating in an on-going stroke secondary prevention trial.
Methods: The Insulin Resistance Intervention after Stroke (IRIS) trial is testing pioglitazone, compared with placebo, for prevention of stroke and myocardial infarction among non-diabetic patients with a recent ischemic stroke/TIA. Preventive care is provided by personal physicians, although achievement of prevention goals is monitored and reported to participants and their physicians annually. Goals are from the American Heart Association guidelines: blood pressure (BP) <140/90 mmHg, statin therapy, and anti-platelet or anticoagulation depending on clinical indications. At baseline and year 1, we compared the proportions of participants meeting these goals in the largest enrolling countries: Canada (CA), United Kingdom (UK) and United States (US).
Results: Participant characteristics were similar across countries, except the proportions of women and blacks were lower in the UK and CA than the US, and self-reported hypertension was more common in US than CA or UK. At baseline, achievement of BP goal was lower in the UK (53%) compared with the US (66%) and CA (75%) (Chi2 p<0.0001). Statin therapy was used more commonly in the UK (91%) and CA (88%) compared with the US (80%) (Chi2 p<0.0001). Differences persisted at year 1. At baseline, use of antithrombotic therapy was high (99%) in all countries. However, at year 1, use fell in US (96%) compared to CA and UK (p=0.02).
Conclusions: Secondary preventive care for stroke varied among 3 countries for BP, statin therapy and antithrombotic therapies despite the IRIS protocol specifying uniform goals. These findings may be the result of disagreement among practitioners in the 3 countries for secondary prevention goals, variability in care delivery, or variability in research implementation. Understanding and resolving variability may lead to more efficient research and improved care for patients.
Author Disclosures: J. Sico: Research Grant; Significant; VA Health Services Research and Development Career Development Award. C. Viscoli: None. A. Tayal: None. D. Spence: None. G. Ford: None. W. Kernan: Research Grant; Significant; National Institute of Neurological Disorders and Stroke.
- © 2015 by American Heart Association, Inc.