A retrospective cohort study examining secondary prevention post stroke in primary care in an Asian setting

Abstract

Background Stroke is one of the top contributors to burden of disability-adjusted life-years worldwide. Family physicians have key role in optimising secondary prevention following stroke by managing clinical risk factors and promoting overall control in accordance with clinical practice guidelines. Methods Our objectives were: (i) to examine level of overall risk factor control together with control of singular risk factors one-year after an index-stroke event in individuals attending primary care facility and (ii) to describe factors associated with satisfactory risk factors control in individuals following stroke. Study Design: Retrospective cohort study. We conducted a study looking retrospectively at records from our electronic chronic disease database. Our study included individuals following stroke who visited primary care setting in Singapore between January 2012 to December 2016. Results There were 24,240 individuals in our study. Overall control was better in individuals without diabetes following stroke (49.2%) as compared to those with diabetes (28.1%). Among individuals without diabetes following stroke, factors significantly associated with overall control were sex (male) [OR (reference: female): 1.23, 95% CI: 1.10, 1.39], ethnicity (Malay) [OR (reference: Chinese): 0.72, 95% CI: 0.58, 0.90], BMI (high risk) [OR (reference: low risk): 0.72, 95% CI: 0.62, 0.84) and atrial fibrillation [OR: 1.47, 95% CI: 1.21, 1.78]. Among individuals with diabetes following stroke, factors significantly associated with overall control were sex (male) [OR (reference: female): 1.28, 95% CI: 1.12, 1.46], ethnicity (Malay) [OR (reference: Chinese): 0.81, 95% CI: 0.65, 0.99], ethnicity (Indian) [OR (reference: Chinese): 0.70, 95% CI: 0.55, 0.88], BMI (high risk) [OR (reference: low risk): 0.71, 95% CI: 0.59, 0.84), BMI (moderate risk) [OR (reference: low risk): 0.84, 95% CI: 0.72, 0.98), atrial fibrillation [OR: 1.24; 95% CI: 1.02, 1.51], chronic kidney disease [OR: 0.63, 95% CI: 0.54, 0.72] and smoking status [OR: 0.68, 95% CI: 0.54, 0.88]. Conclusion We reported sub-optimal level of overall control. Among individuals following stroke, those with diabetes had higher proportion of sub-optimal control as compared to those without diabetes. Irrespective of diabetic status, being female, having high BMI, and of Malay ethnicity as compared to Chinese ethnicity were associated with poorer overall risk factor control.

Functional status and its related factors among stroke survivors in rehabilitation departments of hospitals in Shenzhen, China: a cross-sectional study

“…Once stroke occurs, the regenerative potential decreases, and the inflammatory responses to this disease increase in the elderly [ 35 , 36 ]. Furthermore, we found that the proportion of stroke survivors aged < 60 years in our study was greater than that in a study conducted in Singapore [ 24 ]. This may be because Shenzhen is one of the most developed cities in China.…”

“…With the increasing prevalence of multiple chronic conditions (MCCs) in stroke survivors, MCCs have a modest association with post-stroke functional outcomes and contribute considerably to functional impairment [ 19 – 23 ]. In Singapore, a recent study confirmed the relationship between MCCs and post-stroke readmission [ 24 ]. A previous study published by our team also found that increased MCCs lead to poorerADL ability in older stroke survivors, although there were no data available on young stroke survivors [ 21 ].…”

Desafios no Tratamento de Idosos Vítimas de Acidente Vascular Encefálico

“…No contexto de AVEi, a prescrição de agentes antiplaquetários, como o ácido acetilsalicílico, ou anticoagulantes, como a varfarina, é comumente indicada para reduzir o risco de eventos tromboembólicos recorrentes. Contudo, a decisão sobre o regime terapêutico específico deve levar em consideração fatores como a etiologia do AVE, comorbidades, riscos de sangramento e a presença de fibrilação atrial, sendo uma decisão personalizada para cada paciente (BANSAL;LEE;SMITH, 2021;FLACH et al, 2020).…”

Management of ischaemic stroke survivors in primary care setting: the road to holistic care

“…Several studies investigated the adherence of primary care settings to secondary stroke prevention guidelines. They revealed that many of these patients were not optimally treated according to guidelines, potentially due to the lack of a holistic, multidisciplinary and patient-orientated follow-up (Table 1 ) [ 74 – 80 ]. Accordingly, a secondary cardiovascular prevention study including patients with previous stroke followed-up in primary care demonstrated that only 53% of them were treated with statins, and 59% did not achieve the optimal BP, despite using antihypertensive treatment [ 81 ].…”