Adherence to Guidelines: Experience of a Canadian Stroke Prevention Clinic

Abstract

Background: Few studies have assessed the performance of stroke prevention clinics. In particular, limited information exists on patient compliance, achievement of therapeutic targets, and related occurrence of vascular events. Methods: We compared our clinical practice to recommendations from published guidelines in newly referred patients for transient ischemic attack (TIA) or ischemic stroke between 2008 and 2010. We monitored our cohort for at least 1 year and assessed for adequacy of vascular risk factor management, drug adherence, and occurrence of nonlethal vascular outcomes. Results: Of 408 patients, 57.8% had a stroke and 42.2% a TIA. The mean age was 68 ± 13 years, and 52% male. Average follow-up was 15.8 months. During follow-up, 253 patients (70.3%) completely achieved their blood pressure target, 151 (45.5%) achieved their low-density lipoprotein (LDL) cholesterol target, and 407 (99.8%) were on antithrombotics. Eighty-nine patients (21.8%) attained optimal therapy status, defined as reaching targets for LDL cholesterol, blood pressure, and antithrombotic use. Adherence to drug therapy was associated with attainment of optimal therapy status (p = 0.01). Diabetes was associated with lower probability of attaining optimal therapy status (odds ratio [OR], 0.36; 95% confidence interval [CI], 0.20-0.66) and blood pressure targets (OR, 0.09; 95% CI, 0.05-0.17). During follow-up, 52 (12.7%) patients had a nonlethal vascular event. Conclusion: Our study shows good attainment of therapeutic goals associated with adherence to drug therapy. However, optimal therapy status and blood pressure targets were more difficult to attain in patients with diabetes; therefore, more intensive preventive efforts may be required for these individuals.

Adherence to Guidelines at a Stroke Prevention Clinic: A Follow-up Study

“…This parallels our previous findings and could be explained by a more strict BP target for the diabetic population. 8 However, the presence of diabetes was associated with a better attainment of LDL-C target. Given that the literature has consistently demonstrated worse lipid profile in diabetic compared to non-diabetic patients, 25,26 it may be possible that a more aggressive lipid management was employed among diabetic patients in our clinic.…”

“…Our multivariate regression models were specified a priori, based on our previous study. 8 Baseline characteristics included were patient sex, diabetes mellitus, hypertension, dyslipidemia, systolic BP, LDL-C, smoking, number of follow-up visits (1 vs. 2 or more), and the length of follow-up. Data were analyzed using SAS version 9.4 (SAS Institute Inc., Cary, NC).…”

“…We previously published our experience pertaining to the performance of our stroke prevention clinic in managing vascular risk factors and reaching recommended therapeutic targets between 2008 and 2010. 8 Since 2014, we have introduced standardized and structured electronic clinical forms to record relevant information during initial and follow-up clinic visits. Our current study not only shows that most patients at our clinic were adequately managed in regard to control of risk factors and antithrombotic therapy compared to other previously published studies [13][14][15] but also that our most recent cohort was generally more successful at attaining the main therapeutic targets for secondary stroke prevention compared to our previous cohort.…”

“…For purposes of comparison with our previously published results, 8 a similar methodology was used, including patient inclusion and exclusion criteria, data collection, outcomes analysis, and data reporting.…”

Stroke prevention in Italy: the role of general practitioners

“…Tutti gli operatori sanitari sono chiamati all'impegno di prevenire l'ictus e le conseguenze inabilitanti dello stesso [6,7]. Il ruolo più importante in questo compito è svolto dai medici di medicina generale (MMG), che per evidenti ragioni di conoscenza e di contatto continuo con i pazienti hanno le maggiori potenzialità per svolgere un'efficace azione preventiva sulla popolazione nell'ambito del Servizio Sanitario Nazionale.…”