Management strategies for high risk stroke patients poor in a majority of cases: study
Toronto, June 9, 2009
Stroke patients less likely to meet treatment targets than heart disease patients
A majority of high-risk stroke patients are less likely to meet clinical treatment targets to prevent repeat stroke episodes 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.
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 the benchmark. (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.
“Stroke is the third leading cause of death in Canada and with its prevalence expected to jump exponentially in the next two decades, we must ensure we have more effective therapeutic strategies 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.”
Medical procedures or ongoing specialty care may improve patients’ awareness and consequent treatment success while inappropriate drug or dose selection, lack of aggressive management, patient nonadherence or limited drug efficacy may pose barriers. 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 better reflect clinical practice.”
The study, which appeared in the Journal of the American Heart Association, was a collaborative effort involving medical professionals from cardiology, endocrinology and neurology at the Hospital led by Dr. Saposnik, Dr. Andrew Yan and Dr. Goodman.
St. Michael's Hospital is a large and vibrant Catholic teaching and research hospital in the heart of Toronto. Fully affiliated with the University of Toronto, St. Michael's Hospital leads with innovation, and serves with compassion. Renowned for providing exceptional patient care, St. Michael's Hospital is a regional trauma centre and downtown Toronto's designated trauma centre for adults.