In-Hospital Initiation of Secondary Stroke Prevention Therapies Yields High Rates of Adherence at Follow-up

Background and Purpose— The Stroke PROTECT (Preventing Recurrence Of Thromboembolic Events through Coordinated Treatment) program systematically implements, at the time of acute transient ischemic attack (TIA) or ischemic stroke admission, 8 medication/behavioral secondary prevention measures known to improve outcome in patients with cerebrovascular disease. The objective of this study was to determine if the high utilization rates previously demonstrated at hospital discharge were maintained at 90 days after discharge. Methods— Data were prospectively collected on consecutively encountered ischemic stroke and TIA patients admitted to a university hospital stroke service beginning September 1, 2002. PROTECT interventions were initiated before hospital discharge in all PROTECT–target (underlying stroke mechanism large vessel atherosclerosis or small vessel disease) and PROTECT–ACS (At-risk for Coronary Sequelae) patients. Adherence to program goals was assessed 3 months after discharge. Results— During the period from September 2002 to August 2003, 144 individuals met criteria for PROTECT intervention. Of the 130 patients (90%) with available day 90 follow-up data, mean age was 72 (range, 37 to 95), and 63% were male. Adherence rates in patients without specific contraindications were 100% for antithrombotics, 99% for statins, 92% for angiotensin-converting enzyme inhibitors/angiotensin receptor blockers, and 80% for thiazides. Awareness of the importance of calling 911 in response to stroke was 87%. Adherence to diet and exercise guidelines were 78% and 70%, respectively. Of the 24 smokers, tobacco cessation was maintained in 20 (83%). Conclusions— High rates of adherence to PROTECT therapies were maintained at 90 days after hospital discharge.

[1]  J. Saver,et al.  PROTECT: A coordinated stroke treatment program to prevent recurrent thromboembolic events , 2004, Neurology.

[2]  C. Anderson,et al.  Ten-Year Risk of First Recurrent Stroke and Disability After First-Ever Stroke in the Perth Community Stroke Study , 2004, Stroke.

[3]  P. Rothwell,et al.  Population based study of early risk of stroke after transient ischaemic attack or minor stroke: implications for public education and organisation of services , 2004, BMJ : British Medical Journal.

[4]  S. Warach,et al.  Acute Ischemic Cerebrovascular Syndrome: Diagnostic Criteria , 2003, Stroke.

[5]  E. Topol,et al.  In-hospital initiation of lipid-lowering therapy after coronary intervention as a predictor of long-term utilization: a propensity analysis. , 2003, Archives of internal medicine.

[6]  P. Sandercock.  Should I start all my ischaemic stroke and TIA patients on a statin, an ACE inhibitor, a diuretic, and aspirin today? , 2003, Journal of neurology, neurosurgery, and psychiatry.

[7]  H. Diener,et al.  Adherence to Secondary Stroke Prevention Strategies – Results from the German Stroke Data Bank , 2003, Cerebrovascular Diseases.

[8]  Carl J Pepine,et al.  ACC/AHA 2002 guideline update for the management of patients with unstable angina and non-ST-segment elevation myocardial infarction--summary article: a report of the American College of Cardiology/American Heart Association task force on practice guidelines (Committee on the Management of Patients , 2002, Journal of the American College of Cardiology.

[9]  S. Majumdar,et al.  How Well Are Hypertension, Hyperlipidemia, Diabetes, and Smoking Managed After a Stroke or Transient Ischemic Attack? , 2002, Stroke.

[10]  A. Gawlinski,et al.  Improved treatment of coronary heart disease by implementation of a Cardiac Hospitalization Atherosclerosis Management Program (CHAMP). , 2001, The American journal of cardiology.

[11]  B. Horne,et al.  Usefulness of in-hospital prescription of statin agents after angiographic diagnosis of coronary artery disease in improving continued compliance and reduced mortality. , 2001, The American journal of cardiology.

[12]  S. Sidney,et al.  Short-term prognosis after emergency department diagnosis of TIA. , 2000, JAMA.

[13]  C. Benesch,et al.  Stroke prevention , 2000, Neurology.

[14]  C. Gentz.  Perceived learning needs of the patient undergoing coronary angioplasty: an integrative review of the literature. , 2000, Heart & lung : the journal of critical care.

[15]  J. Alger,et al.  Impact on stroke subtype diagnosis of early diffusion-weighted magnetic resonance imaging and magnetic resonance angiography. , 2000, Stroke.

[16]  C. Wolfe,et al.  Antithrombotic and antihypertensive management 3 months after ischemic stroke : a prospective study in an inner city population. , 2000, Stroke.

[17]  I. Hughes,et al.  Androgen Receptors in Bone-Forming Tissue , 1999, Hormone Research in Paediatrics.

[18]  C. Anderson,et al.  Long-term risk of first recurrent stroke in the Perth Community Stroke Study. , 1998, Stroke.

[19]  R. Sacco,et al.  Risk factors for early recurrence after ischemic stroke: the role of stroke syndrome and subtype. , 1998, Stroke.

[20]  D. Matchar.  The value of stroke prevention and treatment , 1998, Neurology.

[21]  J Bamford,et al.  Long-term risk of recurrent stroke after a first-ever stroke. The Oxfordshire Community Stroke Project. , 1994, Stroke.

[22]  T. Murphy,et al.  Stroke Prevention , 2005, BMJ clinical evidence.

[23]  J. Mckenney,et al.  Executive Summary of The Third Report of The National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, And Treatment of High Blood Cholesterol In Adults (Adult Treatment Panel III). , 2001, JAMA.