A definitive trial of urgent carotid surgery would need to screen large numbers of patients but could focus on patients with partial anterior circulation infarcts.
SUMMARY This study assessed by means of a postal questionnaire how general practitioners (GPs) manage patients at risk from stroke. Of the 640 GPs sent a questionnaire, 294 (46%) replied. In patients with a recent transient ischaemic attack or minor ischaemic stroke, 24% of responding GPs would not arrange any investigations. Sixty‐one per cent refer under half of their patients for further investigation, although 99% of GPs would commence aspirin. Seventy‐seven per cent of GPs were aware of the benefits of carotid surgery. For patients in atrial fibrillation, most GPs (77%) thought that warfarin reduced stroke rates, but only 20% would consider commencing warfarin, although 26% would commence aspirin. In hypertensive patients, the GPs' threshold for treatment ranged from 135 to 200mmHg systolic (median 160mmHg), and from 90 to 110mmHg diastolic (median 100mmHg). Most GPs (84%) would treat isolated systolic hypertension with a median threshold of 180mmHg (range 140‐240mmHg). The results of this study suggest that some patients at risk from stroke may not receive optimal investigation and treatment in the community.
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