Hostname: page-component-76fb5796d-x4r87 Total loading time: 0 Render date: 2024-04-25T20:20:01.029Z Has data issue: false hasContentIssue false
  • English
  • Français

The Impact of a Stroke Prevention Clinic in Diagnosing Modifiable Risk Factors for Stroke

Published online by Cambridge University Press:  02 December 2014

Mikael S. Mouradian ,
Muhammad S. Hussain ,
Harris Lari ,
Abdul Salam ,
Ambikaipakan Senthilselvan ,
Naeem Dean  and
Ashfaq Shuaib
Mikael S. Mouradian
Affiliation:
Division of Neurology, University of Alberta, Edmonton, AB, Canada
Muhammad S. Hussain
Affiliation:
Division of Neurology, University of Alberta, Edmonton, AB, Canada
Harris Lari
Affiliation:
Division of Neurology, University of Alberta, Edmonton, AB, Canada
Abdul Salam
Affiliation:
Division of Neurology, University of Alberta, Edmonton, AB, Canada
Ambikaipakan Senthilselvan
Affiliation:
Division of Neurology, University of Alberta, Edmonton, AB, Canada
Naeem Dean
Affiliation:
Division of Neurology, University of Alberta, Edmonton, AB, Canada
Ashfaq Shuaib*
Affiliation:
Department of Epidemiology, University of Alberta, Edmonton, AB, Canada
*
2E3.13 Walter C. Mackenzie Health Sciences Center, University of Alberta, Edmonton, Alberta, Canada T2G 2B7
Rights & Permissions [Opens in a new window]

Abstract:

Core share and HTML view are not available for this content. However, as you have access to this content, a full PDF is available via the ‘Save PDF’ action button.
Objective:

To evaluate the referral patterns of patients to a stroke prevention clinic (SPC) and to test the adequacy of pre-referral diagnosis and management of modifiable risk factors for stroke.

Methods:

We collected prospective data on consecutive patients referred to the SPC at University of Alberta Hospital in Edmonton, Alberta, Canada. Outcome measures included: alternate diagnoses to stroke or transient ischemic attack (TIA), uncontrolled or undiagnosed hypertension, hyperlipidemia and diabetes, therapies, and investigations leading to carotid endarterectomy.

Results:

Two thousand and eleven patients were referred to SPC. Nearly 25% of the referrals originated from the emergency room and the rest from general physicians. Of the referrals, 68.7% were confirmed as TIA or stroke at the SPC. Among 1381 patients with TIA or stroke, 736 had history of hypertension. Uncontrolled hypertension was found in 265 patients (36.0% of those with hypertension: 95% CI: 32.5–39.5) while undiagnosed hypertension was found in 103 (15.9% of those without hypertension: 95%CI: 13.14-18.79). History of hyperlipidemia was present in 451 patients (32.6%) and 356 (78.9%: 95% CI: 75.2-82.69) of these patients were not at target for secondary prevention. Among 930 patients without history of hyperlipidemia, 739 (79.5%: 95% CI: 76.8-82.1) were diagnosed with hyperlipidemia through the SPC. Fasting blood glucose levels above 7.1 mmol/L in patients with and without history of diabetes were 221 (79.2%: 95% CI: 74.5-83.9) and 66 (6%: 95%CI: 4.6-7.4) respectively.

Conclusions:

Management of risk factors for stroke needs improvement. SPCs should consider actively managing the classical modifiable risk factors of stroke.

Résumé:

RÉSUMÉ:Objectif:

Évaluer le profil d’orientation de patients vers une clinique de prévention le l’accident vasculaire cérébral (CPAVC) et la pertinence du diagnostic et de la prise en charge des facteurs de risque modifiables de l’accident vasculaire cérébral (AVC).

Méthodes:

Nous avons recueilli des données prospectives sur des patients consécutifs référés à la CPAVC du University of Alberta Hospital à Edmonton, Alberta, Canada. Nous avons évalué les résultats suivants: les diagnostics autres que l’AVC ou l’ischémie cérébrale transitoire (ICT), l’hypertension, l’hyperlipidémie ou le diabète non contrôlé ou non diagnostiqué, les traitements et les évaluations menant à l’endartérectomie carotidienne.

Résultats:

Deux mille onze patients ont été référés à la CPAVC. Presque le quart de ces patients étaient référés par le service d’urgences et les autres étaient référés par des praticiens généraux. Chez 68,7% des patients le diagnostic d’ICT ou d’AVC a été confirmé à la CPAVC. Parmi les 1381 patients ayant subi une ICT ou un AVC, 736 avaient une histoire d’hypertension. Une hypertension non contrôlée a été diagnostiquée chez 265 patients (36,0% des patients hypertendus ; IC 95% : 32,5 à 39,5), un diagnostic d’hypertension non reconnue a été posé chez 103 patients (15,9% de ceux qui n’étaient pas hypertendus ; IC 95% : 13,14 à 18,79). Une histoire d’hyperlipidémie était présente chez 451 patients (32,6%) et 356 d’entre eux (78,9% ; IC 95%: 75,2 à 82,69) n’avaient pas atteint les valeurs cibles de traitement chez des patients en prévention secondaire. On a posé un diagnostic d’hyperlipidémie à la CPAVC chez 739 patients (79,5% ; IC 95% : 76,8 à 82,1) des 930 patients sans histoire d’hyperlipidémie. Une glycémie à jeun au-dessus de 7,1 mmol/L était présente chez 221 patients ayant une histoire de diabète (79,2% ; IC 95% : 74,5 à 83,9) et chez 66 patients sans histoire de diabète (6% ; IC 95% : 4,6 à 7,4).

Conclusions:

La prise en charge des facteurs de risque de l’AVC doit être améliorée. Les CPAVC devraient envisager une prise en charge active des facteurs de risque modifiables classiques de l’AVC.

Type
Original Articles
Information
Canadian Journal of Neurological Sciences , Volume 32 , Issue 4 , November 2005 , pp. 496 - 500
Copyright
Copyright © The Canadian Journal of Neurological 2005

References

1. Wolf, PA, Clagett, PA, Easton, JD, et al. Preventing ischemic stroke inpatients with prior stroke and transient ischemic attack. Stroke 1999;30:1991–1994.Google Scholar
2. Straus, SE, Majumdar, SR, McAlister, FA. New evidence for strokeprevention. Scientific review. JAMA 2002;288:1396–1398.Google Scholar
3. Mouradian, M, Majumdar, SR, Senthilselvan, A, Khan, K, Shuaib, A. How well are hypertension, hyperlipidemia, diabetes, and smoking managed after stroke or transient ischemic attack? Stroke 2002;33:1656–1659.Google Scholar
4. Joseph, LN, Babikian, VL, Allen, NC, Winter, MR. Risk factormodification in stroke prevention: the experience of a strokeclinic. Stroke 1999;30:16–20.Google Scholar
5. Kalra, L, Perez, I, Melboun, A. Stroke risk management. Changes inmainstream practice. Stroke 1998;29:53–57.CrossRefGoogle ScholarPubMed
6. Sappok, T, Faulstich, A, Stuckert, E, et al. Compliance with secondaryprevention of ischemic stroke. A prospective evaluation. Stroke 2001;32:1884–1889.Google Scholar
7. Holloway, RG, Benesch, C, Rush, SR. Stroke prevention. Narrowingthe evidence-practice gap. Neurology 2000;54:1899–1906.Google Scholar
8. Holloway, RG, Rush, SR. Quality improvement in stroke prevention. In: The prevention of stroke, Gorelick, PB, Alter, M. editors, Parthenon Publishing, 2002; 141–147.Google Scholar
9. Goldstein, LB. Gaps in professional and community knowledgeabout stroke prevention and treatment. In: Gorelick, PB, Alter, M. (Eds). The Prevention of Stroke, New York, Parthenon Publishing, 2002: 149–154.Google Scholar
10. Marques-Vidal, P, Tuomilehto, J. Hypertension awareness, treatmentand control in the community: is the “rule of halves” still valid? J Hum Hypertens 1997;11:213–220.Google Scholar
11. Joffers, MR, Ghadrian, P, Fodod, JG, et al. Awareness, treatment andcontrol of hypertension in Canada. Am J Hypertens 1997;10:1097–1102.Google Scholar
12. Colhoum, HM, Dong, W, Poulter, NR. Blood pressure screening,management and control in England: results from the health survey for England 1994. J Hypertens 1998;16:747–752.Google Scholar
13. Lantino-Ang, LG Epidemiology of diabetes in Western Pacificregion: focus on Philippines. Diabetes Res Clin Pres 2000;50:S29-S34.Google Scholar
14. Ihab, H, Kotchen, TA. Trends in prevalence, awareness, treatment,and control of hypertension in the United States, 1998-2000. JAMA 2003;290:199–206.Google Scholar
15. Lloyd, DM, Evans, JC, Larson, MG, et al. Differential control ofsystolic and diastolic blood pressure. Hypertension 2000;36:594–599.Google Scholar
16. Wolf-Maier, K, Cooper, KS, Benegas, JR, et al. Hypertensionprevalence and blood pressure levels in 6 European countries, Canada and the United States. JAMA 2003;289:2362–2369).Google Scholar
17. Joint National Committee on prevention, detection, evaluation andtreatment of high blood pressure: the sixth report of the Joint National Committee on prevention, detection, evaluation and treatment of high blood pressure. Arch Intern Med 1997;157:2413–2446.Google Scholar
18. Executive Summary of the Third Report of the National CholesterolEducation Program (NCEP) expert panel on detection, evaluation, and treatment of high blood cholesterol in adults(Adult Treatment Panel III). J Am Med Assoc 2001;285:2486–2497.Google Scholar
19. The Expert Committee on the Diagnosis and Classification of Diabetes Mellitus. Report of the Expert Committee on the diagnosis and classification of diabetes mellitus. Diabetes Care 2000;23;Suppl. 1:S4-S19.Google Scholar
20. North American Symptomatic Carotid Endarterectomy TrialCollaborators. Beneficial effect of carotid endarterectomy in symptomatic patients with high-grade carotid stenosis. N Engl J Med 1991;325:445–453.Google Scholar
21. Barnett, H.J.M, Taylor, D.W, Eliasziw, M, et al. Meldrum H.E.Benefit of carotid endarterectomy in patients with symptomatic moderate or severe stenosis. N Engl J Med 1998;339:1415–1425.Google Scholar
22. Statistical Packages for Social sciences SPSS (Release 11.01,Standard Version, copy right © SPSS inc., 1989–2001.Google Scholar
23. PROGRESS Collaborative Group. Randomizedtrialof aperindopril-based blood pressure-lowering regimen among 6105 individuals with previous stroke or transient ischemic attack. Lancet 2001;358:1033–1041.Google Scholar
24. The ALLHAT Officers and Coordinators for the ALLHAT Collaborative Research Group. Major outcomes in high-risk hypertensive patients randomized to angiotensin-converting enzyme inhibitor or calcium channel blocker vs diuretic. JAMA 2002;288:2981–2997.Google Scholar
25. Heart Protection Study Collaborative Group. MRC/BHF HeartProtection Study of cholesterol lowering with simvastatin in 20536 high-risk individuals: a randomized placebo-controlledtrial. Lancet 2002;360:7–22.Google Scholar
26. Saxena, R, Koudstall, P. Anticoagulants versus antiplatelet therapyfor preventing stroke in patients with nonrheumatic atrial fibrillation and a history of stroke or transient ischemic attack. Cochrane Database Syst Rev 2004:CD000187.Google Scholar
27. Bonita, R, Beaglehole, R. The enigma of the decline in stroke deathsin the United States. The search for an explanation. Stroke 1996;27:370–372.Google Scholar
28. Joint National Committee: The Fifth Report of the Joint NationalCommittee on detection, evaluation, and treatment of high bloodpressure. NIH Publication no. 93-1088. NIH, Bethesda, MD, 1993.Google Scholar
29. Khan, N, Chockalingam, A, Campbel, NRC. Lack of control of highblood pressure and treatment recommendations in Canada. Can J Cardiol 2002;18:657–661.Google Scholar
30. PATS Collaborating Group. Post-stroke antihypertensive treatmentstudy: a preliminary result. Chin Med J 1995;108:710–717 Google Scholar
31. Majumdar, SR, Gurwitz, JH, Soumerai, S. Undertreatment ofhyperlipidemia in the secondary prevention of coronary arterydisease. J Gen Intern Med 1999;14:711–717.Google Scholar
32. Folkis, JP, Zyzanski, SJ, Schwartz, JM, Suhan, PS. Physiciannoncompliance with the 1993 National Cholesterol EducationProgram (NCEP-ATPII) guidelines. Circulation 1998;98:851–855.Google Scholar
33. Perry, JR, Szalai, JP, Norris, JW. For the Canadian StrokeConsortium. Consensus against both endarterectomy and routine screening for asymptomatic carotid artery stenosis. Arch Neurol 1997;54:25–28.Google Scholar
34. Auditing carotid endarterectomy: A regional experience. Findlay, JM, Nykolyn, L, Lubkey, TB, et al. Can J Neurol Sci 2002;29:326–332.Google Scholar