Original Article
Long-term Adherence to National Guidelines for Secondary Prevention of Ischemic Stroke: A Prospective Cohort Study in a Public Hospital in Chile

https://doi.org/10.1016/j.jstrokecerebrovasdis.2013.04.013Get rights and content

Background

Clinical guidelines for the secondary prevention of ischemic stroke have been developed, but their publication is insufficient to make them effective. Our aim was to investigate adherence to Chilean guidelines, its associated variables, and to determine prognosis at follow-up.

Methods

We prospectively included all consecutive patients discharged with a diagnosis of ischemic stroke from Valparaíso Regional Hospital between July 15, 2007 and January 15, 2008. Patient follow-up was performed at 5, 10, and 15 months using a standardized questionnaire. We used the Chi-square and Fisher exact tests to compare discrete variables and multivariate logistic regression analysis to adjust for potential confounding factors. A Cox regression model was fitted.

Results

We included 156 patients; 128 patients (82%) completed follow-up. Adherence to oral anticoagulation decreased significantly compared to all other medications during follow-up (P = .004). This was not associated with any of the studied variables. Adherence to antihypertensives, statins, and hypoglycemic medications remained >65% without a significant variation. Patients with cardioembolic stroke had greater mortality (P = .003) and recurrence rates.

Conclusions

The observed significant decrease in adherence to oral anticoagulation in patients with cardioembolic stroke suggests a need for the implementation of specific strategies to achieve the desired secondary prevention goals in these patients. Future research into the evaluation of other factors that could be associated with the lack of adherence to these guidelines, measurements of therapeutic goals, and new therapeutic strategies that are easier to use and that are associated with less risk could improve the prognosis of these patients.

Section snippets

Date and Participants

We prospectively included all consecutive patients with a diagnosis of IS (cerebral infarct or transient ischemic attack [TIA]) who were discharged from Valparaíso Regional Hospital, Chile, between July 15, 2007 and January 15, 2008.

Context

Valparaíso Regional Hospital is a tertiary level university medical center located in the third most populated region of Chile, which is primarily urban (92%). This 540-bed hospital is the primary center providing health care services to 466,143 inhabitants and is

Results

During the study period, 156 patients with a diagnosis of IS were discharged from the hospital; 137 (88%) had a cerebral infarction and 19 (12%) had a TIA. This cohort was followed and surveyed at 5, 10, and 15 months. One hundred twenty-eight patients (82%) completed the follow-up (mean ± SD 381 ± 148 days). Of those who did not complete the follow-up, 24 (15%) could not be contacted and 4 (3%) patients refused to answer the telephone survey. Thirty patients (19%) died during the study.

Discussion

In the present study, we found that adherence to guidelines for the secondary prevention of ischemic stroke is lower than it should be and that it varies significantly depending on the prescription. The most notable finding was the significant decrease of adherence to oral anticoagulant therapy in patients with cardioembolic stroke, which was as low as 7% at the end of the follow-up period. This group of patients had the highest mortality and recurrence of cerebrovascular events. Adherence to

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    • Effectiveness of Goal-Setting Telephone Follow-Up on Health Behaviors of Patients with Ischemic Stroke: A Randomized Controlled Trial

      2016, Journal of Stroke and Cerebrovascular Diseases
      Citation Excerpt :

      One such intervention is the “Get with the Guidelines-Stroke” program of the American Heart Association/American Stroke Association used to improve the quality of postdischarge care for patients with stroke.25 However, adherence to guidelines for the secondary prevention of ischemic stroke is highly variable.26 Goal setting is a process in which people set targets and work toward achieving them.27

    Dr. Muñoz-Venturelli receives research support from The George Institute. Dr. Sacks has served as member of the editorial advisory board of the Stroke Journal, Spanish Edition since 2009, and has received honoraria from Ferrer Group. Dr. Lavados serves on the scientific advisory boards for BMS, Pfizer, and Sanofi-Aventis, has received funding for travel from Boehringer Ingelheim, Ferrer Group, and Sanofi-Aventis, and receives research support from The George Institute and Lundbeck.

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