An evaluation of medical management for secondary prevention of ischaemic stroke in a tertiary stroke centre

Abstract

Abstract Background Recurrent ischaemic strokes occur in 9-15% of patients within one year, the majority occurring within the first ninety days and up to 25% of patients who recover from a stroke are likely to have another stroke event within five years. Prompt introduction and optimisation of pharmacological therapy is essential for reducing recurrence. The mainstay of secondary prevention includes antiplatelet agents or anticoagulants, lipid lowering therapy and medications to optimise blood pressure and diabetes control. The primary aim of this study was to evaluate the current adherence to secondary prevention strategies in a tertiary stroke centre with a secondary aim of assessing achievement of target recommendations for LDL-C, HbA1c and blood pressure. Methods A retrospective chart review was conducted in a tertiary stroke centre. Patients were included if they were aged over 18 years and presenting to an outpatient stroke clinic with a diagnosis of an ischaemic stroke. Results A total of 49 patients were reviewed with 40 meeting our inclusion criteria. The median age was 69 years (range 42-90years) and 70% (n=28) were male. Four patients (10%) had a documented history of more than one ischaemic stroke. All patients were appropriately prescribed an anti-thrombotic agent and a cholesterol-lowering medication. 40% (n=16) of patients had LDL-C results above target (<1.8mmol/L; median 2; range 0.6-6.4). 30% (n=12) patients had a documented history of diabetes mellitus with a median HbA1c level of 42mmol/mol (range 28-87mmol/mol). No patient had a documented 24 hour blood pressure monitor result. Conclusion A significant number of patients attending their first follow-up appointment post stroke had inadequate lipid and diabetic control. Regular monitoring and target-driven therapy allow for regular optimisation of secondary prevention therapy which is crucial for improving clinical outcomes preventing recurrence.