Implementation of clinical practice guidelines for acute ischaemic stroke in specialist care centres

Abstract

Introduction: Cerebrovascular disease is associated with high morbidity and mortality. In 2008, the Spanish Ministry of Health published its Clinical Practice Guidelines for stroke prevention, but implementation of that document has not yet been assessed. Our study aims to investigate compliance with the Guidelines by analysing control over vascular risk factors, antithrombotic treatment and lipid lowering treatment in patients who had suffered an acute ischaemic stroke and who were under the care of neurologists or internists.Methods: Cross-sectional study based on data from clinical reports (vascular risk factors, diagnosis and treatment), blood pressure readings and laboratory tests pertaining to 203 patients diagnosed with acute ischaemic stroke and admitted to a medium-to-long stay hospital for rehabilitation and care.Results: The mean patient age was 75 ± 10 years; 56% were women. The most common risk factors were hypertension (68%) and diabetes mellitus (40%). Intravenous fibrinolytic therapy had been administered to 8.9% of the patients. Of the patients with thrombotic cerebral infarction, 91.7% received antiplatelet agents; 59.4% of patients with embolic infarction received anticoagulants. Statins were prescribed to 65% of patients with thrombotic infarction. Laboratory tests upon admission showed that 23% of patients had total cholesterol levels above 175 mg/dl and 26.6% had plasma glucose levels above 126 mg/dl. Of the patient total, 70% received antihypertensive therapy, but 47.5% had blood pressure levels above 130/80 mm Hg.Conclusions: In our opinion, secondary prevention of acute cerebrovascular disease could be improved, mainly by increasing the percentage of patients treated with antiplatelet or anticoagulant drugs (depending on aetiology), increasing prescription of statins, and improving blood pressure control. Implementación de las guías de práctica clínica sobre ictus isquémico agudo en atención especializada Resumen Introducción: La enfermedad cerebrovascular se asocia a una elevada morbimortalidad. En el año 2008, el Ministerio de Sanidad publicó la «Guía de práctica clínica» sobre prevención del ictus sin que se haya evaluado su implementación. Nos planteamos investigar el seguimiento de dicha guía a través del análisis del control de factores de riesgo vascular y el tratamiento antitrombótico e hipolipemiante en pacientes con ictus isquémico agudo atendidos por neuról-ogos o internistas.Métodos: Estudio transversal descriptivo basado en los datos obtenidos de informes clínicos (factores de riesgo vascular, diagnóstico y tratamientos), cifras tensionales y analíticas de 203 pacientes con diagnóstico principal de ictus isquémico agudo que ingresaron para rehabilitación y cuidados en un hospital de media-larga estancia.Resultados: La edad media ± DE de los pacientes incluidos fue de 75 ± 10 años con un 56% de mujeres. Los factores de riesgo más frecuentes fueron hipertensión arterial (68%) y diabetes mellitus (40%). El 8,9% de los pacientes había recibido fibrinólisis por vía intravenosa. El...

Scientific Rigor Recommendations for Optimizing the Clinical Applicability of Translational Research

“…The majority of AIS patients are also not antihypertensive agent naive [24,25], and may also receive anticoagulants, statins or other treatments [24]. These points are critical to the development of a translational research program, when an investigator must utilize the “correct” animal model for drug development.…”