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

Abstract

THE CANADIAN JOURNAL OF NEUROLOGICAL SCIENCESStroke prevention clinics (SPCs) are a relatively recent and evolving phenomenon in the delivery of specialized health care. Patients can be seen very early after a cerebrovascular event and stated targets for risk assessment such as hypertension, hyperlipidemia, smoking, atrial fibrillation, and internal carotid artery stenosis can be made. In addition, appropriate medical and surgical interventions such as antiplatelet or anticoagulation treatment, blood pressure management, cholesterol lowering agents, and carotid endarterectomy can be initiated for secondary prevention. 1.2 Little is known about the referral patterns to SPCs ABSTRACT: Objective: To evaluate the referral patterns of patients to a stroke prevention clinic (SPC) and to test the adequacy of prereferral 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: L'impact d'une clinique de prévention de l'accident vasculaire cérébral sur le diagnostic des facteurs de risque modifiables de l'accident vasculaire cérébral. 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 a...

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