Ambulatory Treatment Gaps in Patients with Ischemic Stroke or Transient Ischemic Attack

Olson, Kari L.; Lash, Lisa J; Delate, Thomas; Wood, Michele; Rasmussen, Jeppe Nørgaard; Denham, Anne M; Merenich, John A.

doi:10.7812/tpp/12-145

Cited by 2 publications

(1 citation statement)

References 25 publications

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“…40 In a study in the United States, of 1,731 patients with ischemic stroke or TIA, only 75% had an LDL-cholesterol measured, 50% had their blood pressure measured, and 48.9% met a target LDL. 41 In Canada, a multicenter registry also found poor control of cholesterol among stroke survivors. 42 These findings suggest the need to improve the overall quality of secondary stroke preventive care.…”

Section: Discussionmentioning

confidence: 99%

Association Between Immigration Status and Ambulatory Secondary Stroke Preventive Care in Ontario, Canada

Vyas,

Saposnik,

et al. 2024

Neurology

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Background and ObjectivesSecondary stroke preventive care includes evaluation and control of vascular risk factors to prevent stroke recurrence. Our objective was to evaluate the quality of ambulatory stroke preventive care and its variation by immigration status in adult stroke survivors in Ontario, Canada. MethodsWe conducted a population-based administrative database-derived retrospective cohort study in Ontario, Canada. Using immigration records, we defined immigrants as those immigrating after 1985 and long-term residents as those arriving before 1985 or those born in Canada. We included community-dwelling stroke survivors 40 years and older with a first-ever stroke between 2011 and 2017. In the year following their stroke, we evaluated the following metrics of stroke prevention: testing for hyperlipidemia and diabetes; among those with the condition, control of diabetes (hemoglobin A1c ≤7%) and hyperlipidemia (low-density lipoprotein <2 mmol/L); medication use to control hypertension, diabetes, and atrial fibrillation; and visit to a family physician and a specialist (neurologist, cardiologist, or geriatrician). We determined age and sex-adjusted absolute prevalence difference (APD) between immigrants and long-term residents for each metric using generalized linear models with binomial distribution and an identity link function. ResultsWe included 34,947 stroke survivors (median age 70 years, 46.9% women) of whom 12.4% were immigrants. The receipt of each metric ranged from 68% to 90%. Compared with long-term residents, after adjusting for age and sex, immigrants were slightly more likely to receive screening for hyperlipidemia (APD 5.58%; 95% CI 4.18-6.96) and diabetes (5.49%; 3.76-7.23), have visits to family physicians (1.19%; 0.49-1.90), receive a prescription for antihypertensive (3.12%; 1.76-4.49) and antihyperglycemic medications (9.51%; 6.46-12.57), and achieve control of hyperlipidemia (3.82%; 1.01-6.63). By contrast, they were less likely to achieve diabetes control (−4.79%; −7.86 to −1.72) or have visits to a specialist (−1.68%; −3.12 to −0.24). There was minimal variation by region of origin or time since immigration in immigrants. DiscussionCompared with long-term residents, many metrics of secondary stroke preventive care were better in immigrants, albeit with small absolute differences. However, future work is needed to identify and mitigate the factors associated with the suboptimal quality of stroke preventive care for all stroke survivors. H0 Null Hypothesis A collection of negative, inconclusive, or replication studies; in partnership with the Center for Biomedical Research Transparency NPub.org/Null

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Section: Discussionmentioning

confidence: 99%

Association Between Immigration Status and Ambulatory Secondary Stroke Preventive Care in Ontario, Canada

Vyas,

Saposnik,

et al. 2024

Neurology

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Apparent Treatment-resistant Hypertension Among Individuals with History of Stroke or Transient Ischemic Attack

Howard

Tanner

Anderson

et al. 2015

The American Journal of Medicine

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Background and Purpose Blood pressure control is a paramount goal in secondary stroke prevention; however, high prevalence of uncontrolled blood pressure and use of multiple antihypertensive medication classes in stroke patients suggest this goal is not being met. We determined the prevalence and factors associated with apparent treatment-resistant hypertension in persons with/without stroke or transient ischemic attack.. Methods Data came from REGARDS, a national, population-based cohort of 30,239 black and white adults ≥ 45 years, enrolled 2003–2007, restricted to 11,719 participants with treated hypertension. Apparent treatment-resistant hypertension was defined as: 1) uncontrolled blood pressure (systolic ≥ 140 mmHg or diastolic ≥ 90 mmHg) with ≥ 3 antihypertensive medication classes, or 2) use of ≥ 4 antihypertensive medication classes, regardless of blood pressure level. Poisson regression was used to calculate characteristics associated with apparent treatment-resistant hypertension. Results Among hypertensive participants, prevalence of apparent treatment-resistant hypertension was 24.9% (422/1,694) and 17.0% (1,708/10,025) in individuals with and without history of stroke or transient ischemic attack, respectively. After adjustment for cardiovascular risk factors, the prevalence ratio for apparent treatment-resistant hypertension for those with versus without stroke or transient ischemic attack was 1.14 (95% CI: 1.03–1.27). Among hypertensive participants with stroke or transient attack, male sex, black race, larger waist circumference, longer duration of hypertension, and reduced kidney function were associated with apparent treatment-resistant hypertension. Conclusions The high prevalence of apparent treatment-resistant hypertension among hypertensive persons with history of stroke or transient ischemic attack suggests the need for more individualized blood pressure monitoring and management.

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Ambulatory Treatment Gaps in Patients with Ischemic Stroke or Transient Ischemic Attack

Cited by 2 publications

References 25 publications

Association Between Immigration Status and Ambulatory Secondary Stroke Preventive Care in Ontario, Canada

Association Between Immigration Status and Ambulatory Secondary Stroke Preventive Care in Ontario, Canada

Apparent Treatment-resistant Hypertension Among Individuals with History of Stroke or Transient Ischemic Attack

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