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NEUROLOGY

Tracking Trends in Secondary Stroke Prevention Strategies

Pharmacy Practice Resident, Medical College of Georgia Health, Augusta, GA

Kemberley A Beard, BS

Pharmacy Student, University of Georgia, Athens, GA

Michele M Chevrette, PharmD

Pharmacy Practice Resident, Children's Hospital of Michigan, Detroit, MI

Carol N Pardue, MSN

Clinical Nurse Specialist/Case Manager, Medical College of Georgia Health Inc.

David C Hess, MD

Professor and Chairman of Neurology, Medical College of Georgia

Susan C Fagan, PharmD

Professor of Pharmacy, College of Pharmacy, University of Georgia

Reprints: Susan C Fagan PharmD, College of Pharmacy, University of Georgia, 1120 15th St., CJ 1020, Augusta, GA 30912-2450, fax 706/721-3914, sfagan{at}mail.mcg.edu

BACKGROUND: Stroke is defined as a rapid onset of isolated neurologic dysfunction and is the leading cause of disability in adults, as well as the third-leading cause of death in the US. Nearly 600 000 cases of stroke are reported annually.

OBJECTIVE: To quantify the impact of emerging evidence on the use of secondary stroke prevention strategies in patients discharged from a specialized stroke center in 2002 compared with those discharged in 2000.

METHODS: Using a retrospective approach, data were collected on the first 100 patients cared for by the stroke service from July 1, 2000, to December 31, 2000. Using a prospective approach, the goal was to enroll 100 patients with a diagnosis of ischemic stroke and telephone the patients 1 and 3 months after discharge to determine patient adherence and persistence rate of medications. This is an interim report of the first 20 patients enrolled.

RESULTS: Both studies resulted in populations of 55% women and 45% men. The most common risk factor was hypertension, with 59% on admission in 2000 and 75% in 2002. Use of antithrombotics (98% in 2000 to 100% in 2002) and antihypertensives (67% in 2000 to 90% in 2002) was high in both studies and not significantly different. The 2 most significant changes in prescribing were increased use of statins (13% in 2000 to 50% in 2002, p = 0.0007) and combination clopidogrel and aspirin use (0% in 2000 to 20% in 2002, p = 0.001). At 3 months, 66.7% of patients were on the same antithrombotic medication as at discharge.

CONCLUSIONS: The dedicated stroke service was able to effectively translate emerging evidence and guidelines into practice and significantly change the use of prescribed medications for secondary stroke prevention.

Key Words: antihypertensives, antithrombotics, hypertension, statins, stroke prevention

Published Online, December 23, 2003. www.theannals.com, DOI 10.1345/aph.1D190

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