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Missed Opportunities in Stroke Prevention
Rates of myocardial infarction and stroke have been declining over the last decade in the U.S. and Europe. However, a recent manuscript suggests there are still significant missed opportunities to prevent stroke.This manuscript presents results of review of electronic primary care records in the United Kingdom.The authors examines a group of over 29,000 subjects with a diagnosis of stroke or transient ischemic attack over a 10 year period.Records were reviewed to assess for compliance with guideline drug treatments that are proven to reduce the incidence of stroke including:Lipid-lowering drugsAnticoagulant drug use in those with atrial fibrillationAntihypertension drug use in hypertensionThe record review found that around 50% of subjects experiencing stroke or TIA had indications but were not receiving lipid-lowering or anticoagulant drugs prior to their cerebrovascular event. For hypertension, compliance with antihypertension drug use was 75% with 25% not receiving drug.One of the attractive features of this type of primary prevention is the potential for electronic records. Centralized records could be scanned with identification of high-risk patients that might benefit from targeted drug therapy. Patients and physicians could be alerted and a medical visit triggered to address the issue.The authors conclude that improving prevention efforts in these areas could potentially reduce the number of first strokes in the U.K. by 12,000 every year.Here is a table from the Creative Commons free full-text manuscript that outlines the indications and methods in the study for use of stroke prevention drugs.I am not aware of a similar type of study of stroke prevention in the United States.We do know that despite some promising trends in stroke reduction, significant geographic challenges remain.This map from the U.S. CDC shows the clustering of high stroke rates in the Southeastern portion of the U.S.Stroke prevention intervention efforts could be directed to areas of high risk for stroke as these areas are likely to yield the greatest results.Readers with more interest in this research can access the free full-text manuscript by clicking on the link in the citation below.U.S. Stroke map is from the U.S. CDC with data source the National Vital Statistics System, National Center for Health Statistics.Follow me on Twitter WRY999Turner GM, Calvert M, Feltham MG, Ryan R, Fitzmaurice D, Cheng KK, & Marshall T (2016). Under-prescribing of Prevention Drugs and Primary Prevention of Stroke and Transient Ischaemic Attack in UK General Practice: A Retrospective Analysis. PLoS medicine, 13 (11) PMID: 27846215... Turner GM, Calvert M, Feltham MG, Ryan R, Fitzmaurice D, Cheng KK, & Marshall T. (2016) Under-prescribing of Prevention Drugs and Primary Prevention of Stroke and Transient Ischaemic Attack in UK General Practice: A Retrospective Analysis. PLoS medicine, 13(11). PMID: 27846215  Under-prescribing of Prevention Drugs and Primary Prevention of Stroke and Transient Ischaemic Attack in UK General Practice: A Retrospective Analysis.