Management strategies for high risk stroke patients poor in a majority of cases: study

June 8, 2009

A majority of high-risk stroke patients are less likely to meet clinical treatment targets to prevent repeat stroke or heart attacks compared to those with heart disease, suggesting the need to examine new therapeutic strategies, according to a study led by St. Michael's Hospital neurologist Dr. Gustavo Saposnik. What's more, medical procedures or ongoing specialty care may improve patients' awareness and consequent treatment success.

The study, an analysis of 4,933 outpatients with a past history of heart attack and cerebrovascular disease (stroke) across Canada, found:

• About 30 per cent of patients with heart disease achieved target blood pressure and LDL-cholesterol levels
  
• Only 20 per cent of stroke patients met target blood pressure and LDL-cholesterol levels. (At the time of the study, Canadian guidelines recommended a LDL-cholesterol target of less than 2.5 mmol/L and a blood pressure target of less than 140/90 mm Hg or less than 130/80 mm Hg for diabetic patients).
  
• Among stroke patients, women were also less likely to meet the targets despite a similar medical history of treatment with antihypertensive and LDL-cholesterol-lowering therapies.
  

"With stroke the third leading cause of death in Canada and its prevalence expected to jump exponentially in the next 20 years, more effective therapeutic strategies are necessary to treat patients," said Dr. Saposnik. "By examining clinical management practices, we can better identify the gaps in patient care so that we can improve the health of stroke and heart disease patients."

According to the study, inappropriate drug or dose selection, lack of aggressive management, patient nonadherence or limited drug efficacy may pose barriers to poor treatment success. The researchers suggest differences in the emphasis of recommended targets between heart and stroke prevention guidelines may account for the gap.

"Despite the effectiveness and benefits of antihypertensive and lipid-lowering therapies, management of heart disease and stroke patients remains poor," said St. Michael Hospital cardiologist Dr. Shaun Goodman, who created the database used in the study. "A significant proportion of patients who failed to meet guidelines within our study were stroke patients and women. Quality improvement strategies should target these patient subgroups so that we can develop benchmarks that can lead to improved clinical practice."

Source: St. Michael's Hospital