Across the UK, that amounts to 33% of all patients who have experienced a stroke or a transient ischaemic attack (TIA) having a “missed opportunity” for preventative treatment.
The findings are published in the journal PLOS Medicine.
Three types of patients are recommended to have drugs to prevent strokes; patients with hypertension, patients who are at high risk of a stroke, such as those with cardiovascular disease (CVD), and patients with atrial fibrillation.
Researcher from the University of Birmingham, Birmingham, United Kingdom, estimate that approximately 12,000 first strokes could be prevented in the United Kingdom each year through optimal prescribing of the drugs.
The team searched electronic medical records from over 500 UK general practices. They identified every patient who suffered a first stroke or a mini-stroke between January 2009 and December 2013.
They then found out how many were known to be at high risk, due to high blood pressure, CVD or high risk of CVD and/or atrial fibrillation before the stroke. They found 29,043 patients with a first stroke or TIA, of whom 17,680 should have been prescribed either drugs to lower blood pressure, a statin, or drugs to prevent blood clots. More than half of those who should were not prescribed the drugs.
At least 1 prevention drug was not prescribed when clinically indicated in 54% of stroke/TIA patients. In addition, 52% of those with atrial fibrillation were not prescribed anticoagulant drugs to prevent blood clots; 49% of those at high risk were not prescribed lipid-lowering statins; and 25% of patients with hypertension were not prescribed antihypertensive drugs.
Between 2009 and 2013 there was no significant reduction in the proportion of stroke/TIA patients with prior missed opportunities for prevention with lipid lowering or antihypertensive drugs; though prescribing of anticoagulant drugs improved during this period.
“These findings suggest a number of missed opportunities to reduce the incidence of strokes,” said Grace Turner, MD, University of Birmingham. “The next step for us is to build on this exploratory study and investigate the reasons for under-prescribing, with a view to developing an intervention that can help to bridge the gap.”
“It’s worth noting that there are instances where not prescribing may be the correct approach,” she added. “For example, there are elderly patients who may be frail and have multiple significant comorbidities who wouldn’t be suitable, and there are patients who actively take part in the decision to not prescribe.”
A limitation of the study is that it only looks at prescribed drugs. Not all patients prescribed drugs take them and they may not be taking enough to bring their blood pressure under control. If anything this means that more patients are undertreated than this study suggests.
SOURCE: University of Birmingham