Age and Ageing Advance Access originally published online on March 26, 2004
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Age and Ageing 2004; 33: 280-286
Age and Ageing Vol. 33 No. 3 © British Geriatrics Society 2004; all rights reserved
Research Paper |
Secondary prevention for stroke in the United Kingdom: results from the National Sentinel Audit of Stroke
1 Clinical Effectiveness and Evaluation Unit, Royal College of Physicians of London, 11 St Andrew’s Place, London NW1 4LE, UK
2 Guys and St Thomas’ Hospital, London SE1 7EH, UK
3 Fazakerley Hospital, Liverpool L9 7AL, UK
Address correspondence to: A. G. Rudd. Fax: (+44) 20 7487 3988. Email: anthony.rudd{at}replondon.ac.uk
Abstract
Study objectives: to measure the quality of secondary prevention of stroke provided to patients in England, Wales and Northern Ireland.
Design: retrospective case note analysis.
Setting: 235 hospitals (95% of all such hospitals), providing care for acute stroke patients in England, Wales and Northern Ireland and primary health care for follow-up data.
Patients: 8,200 patients admitted with stroke between 1st April and 30th June 2001. Data on up to 40 consecutive cases submitted by each hospital.
Audit tool: Royal College of Physicians Intercollegiate Stroke Working Party Stroke Audit.
Results: 24% of patients with previous cerebrovascular disease were not on anti-thrombotic medication at the time of admission. Nine percent of appropriate patients were not taking anti-thrombotic medication at discharge. Patients left with moderate to very severe disability (Barthel scores 14 or less) compared with those independent with mild disability (Barthel score 15–20) were more likely not to have anti-thrombotic treatment (18% versus 8%). Fifty-four percent of patients with known hyperlipidaemia and 21% of those with previous ischaemic heart disease were on lipid lowering therapy on admission. Sixty-four percent of patients had lipids measured during their hospital stay and of those with high total cholesterol or LDL the rate of non-treatment was 36%. Older patients (75+ years) were less likely to be treated (54%) than those <65 years (71%). Seventy-nine percent of known patients with hypertension were on treatment at admission, with 78% being treated by discharge from hospital. At 6 months after stroke a systolic blood pressure of 140 mmHg or less, and a diastolic of 85 mmHg or less, was achieved in 41% of known pre-stroke hypertensives on treatment, 31% of previously untreated hyper-tensives but on treatment at follow-up and 40% of patients not previously labelled as hypertensive.
Conclusions: major deficiencies in delivery of secondary prevention after stroke have been demonstrated. Services need reorganisation to prevent unnecessary mortality and morbidity in this group of patients.
Keywords: stroke, cardiovascular disease, risk factors, prevention, elderly
Received August 15, 2003; Revision received December 4, 2003. accepted in revised form December 4, 2003.
CiteULike 
Connotea 
Del.icio.us What's this?
This article has been cited by other articles:
|
|
 |
|
  Y-Y K Kee, W Brooks, and A Bhalla Do older patients receive adequate stroke care? An experience of a neurovascular clinic Postgrad. Med. J., March 1, 2009; 85(1001): 115 - 118. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S. E. Ramsay, P. H. Whincup, S. G. Wannamethee, O. Papacosta, L. Lennon, M. C. Thomas, and R. W. Morris Missed opportunities for secondary prevention of cerebrovascular disease in elderly British men from 1999 to 2005: a population-based study J. Public Health Med., September 1, 2007; 29(3): 251 - 257. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. de Lusignan, J. Belsey, N. Hague, N. Dhoul, and J. van Vlymen Audit-based education to reduce suboptimal management of cholesterol in primary care: a before and after study J. Public Health Med., December 1, 2006; 28(4): 361 - 369. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. F Fairhead and P. M Rothwell Underinvestigation and undertreatment of carotid disease in elderly patients with transient ischaemic attack and stroke: comparative population based study BMJ, September 9, 2006; 333(7567): 525 - 527. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 K. I. Paraskevas, S. S. Daskalopoulou, M. E. Daskalopoulos, and C. D. Liapis Secondary Prevention of Ischemic Cerebrovascular Disease. What Is the Evidence? Angiology, September 1, 2005; 56(5): 539 - 552. [Abstract] [PDF]
|
|
|
|
 |
|
 C. McKevitt, C. Coshall, K. Tilling, and C. Wolfe Are There Inequalities in the Provision of Stroke Care?: Analysis of an Inner-City Stroke Register Stroke, February 1, 2005; 36(2): 315 - 320. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. Dobson Stroke prevention opportunities are being lost, study shows BMJ, April 24, 2004; 328(7446): 975. [Full Text]
|
|