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The Impact of a Stroke Prevention Clinic in Diagnosing Modifiable Risk Factors for Stroke

Published online by Cambridge University Press:  02 December 2014

Mikael S. Mouradian ,
Muhammad S. Hussain ,
Harris Lari ,
Abdul Salam ,
Ambikaipakan Senthilselvan ,
Naeem Dean  and
Ashfaq Shuaib
Mikael S. Mouradian
Affiliation:
Division of Neurology, University of Alberta, Edmonton, AB, Canada
Muhammad S. Hussain
Affiliation:
Division of Neurology, University of Alberta, Edmonton, AB, Canada
Harris Lari
Affiliation:
Division of Neurology, University of Alberta, Edmonton, AB, Canada
Abdul Salam
Affiliation:
Division of Neurology, University of Alberta, Edmonton, AB, Canada
Ambikaipakan Senthilselvan
Affiliation:
Division of Neurology, University of Alberta, Edmonton, AB, Canada
Naeem Dean
Affiliation:
Division of Neurology, University of Alberta, Edmonton, AB, Canada
Ashfaq Shuaib*
Affiliation:
Department of Epidemiology, University of Alberta, Edmonton, AB, Canada
*
2E3.13 Walter C. Mackenzie Health Sciences Center, University of Alberta, Edmonton, Alberta, Canada T2G 2B7
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Abstract:

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Objective:

To evaluate the referral patterns of patients to a stroke prevention clinic (SPC) and to test the adequacy of pre-referral diagnosis and management of modifiable risk factors for stroke.

Methods:

We collected prospective data on consecutive patients referred to the SPC at University of Alberta Hospital in Edmonton, Alberta, Canada. Outcome measures included: alternate diagnoses to stroke or transient ischemic attack (TIA), uncontrolled or undiagnosed hypertension, hyperlipidemia and diabetes, therapies, and investigations leading to carotid endarterectomy.

Results:

Two thousand and eleven patients were referred to SPC. Nearly 25% of the referrals originated from the emergency room and the rest from general physicians. Of the referrals, 68.7% were confirmed as TIA or stroke at the SPC. Among 1381 patients with TIA or stroke, 736 had history of hypertension. Uncontrolled hypertension was found in 265 patients (36.0% of those with hypertension: 95% CI: 32.5–39.5) while undiagnosed hypertension was found in 103 (15.9% of those without hypertension: 95%CI: 13.14-18.79). History of hyperlipidemia was present in 451 patients (32.6%) and 356 (78.9%: 95% CI: 75.2-82.69) of these patients were not at target for secondary prevention. Among 930 patients without history of hyperlipidemia, 739 (79.5%: 95% CI: 76.8-82.1) were diagnosed with hyperlipidemia through the SPC. Fasting blood glucose levels above 7.1 mmol/L in patients with and without history of diabetes were 221 (79.2%: 95% CI: 74.5-83.9) and 66 (6%: 95%CI: 4.6-7.4) respectively.

Conclusions:

Management of risk factors for stroke needs improvement. SPCs should consider actively managing the classical modifiable risk factors of stroke.

Résumé:

RÉSUMÉ: Objectif:

Évaluer le profil d’orientation de patients vers une clinique de prévention le l’accident vasculaire cérébral (CPAVC) et la pertinence du diagnostic et de la prise en charge des facteurs de risque modifiables de l’accident vasculaire cérébral (AVC).

Méthodes:

Nous avons recueilli des données prospectives sur des patients consécutifs référés à la CPAVC du University of Alberta Hospital à Edmonton, Alberta, Canada. Nous avons évalué les résultats suivants: les diagnostics autres que l’AVC ou l’ischémie cérébrale transitoire (ICT), l’hypertension, l’hyperlipidémie ou le diabète non contrôlé ou non diagnostiqué, les traitements et les évaluations menant à l’endartérectomie carotidienne.

Résultats:

Deux mille onze patients ont été référés à la CPAVC. Presque le quart de ces patients étaient référés par le service d’urgences et les autres étaient référés par des praticiens généraux. Chez 68,7% des patients le diagnostic d’ICT ou d’AVC a été confirmé à la CPAVC. Parmi les 1381 patients ayant subi une ICT ou un AVC, 736 avaient une histoire d’hypertension. Une hypertension non contrôlée a été diagnostiquée chez 265 patients (36,0% des patients hypertendus ; IC 95% : 32,5 à 39,5), un diagnostic d’hypertension non reconnue a été posé chez 103 patients (15,9% de ceux qui n’étaient pas hypertendus ; IC 95% : 13,14 à 18,79). Une histoire d’hyperlipidémie était présente chez 451 patients (32,6%) et 356 d’entre eux (78,9% ; IC 95%: 75,2 à 82,69) n’avaient pas atteint les valeurs cibles de traitement chez des patients en prévention secondaire. On a posé un diagnostic d’hyperlipidémie à la CPAVC chez 739 patients (79,5% ; IC 95% : 76,8 à 82,1) des 930 patients sans histoire d’hyperlipidémie. Une glycémie à jeun au-dessus de 7,1 mmol/L était présente chez 221 patients ayant une histoire de diabète (79,2% ; IC 95% : 74,5 à 83,9) et chez 66 patients sans histoire de diabète (6% ; IC 95% : 4,6 à 7,4).

Conclusions:

La prise en charge des facteurs de risque de l’AVC doit être améliorée. Les CPAVC devraient envisager une prise en charge active des facteurs de risque modifiables classiques de l’AVC.

Type
Original Articles
Information
Canadian Journal of Neurological Sciences , Volume 32 , Issue 4 , November 2005 , pp. 496 - 500
Copyright
Copyright © The Canadian Journal of Neurological 2005

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