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Second Stroke Prevention Efforts Found Wanting

Many patients not getting services they need to prevent another attack, researchers say,,,,

THURSDAY, March 5 (HealthDay News) -- After suffering a stroke, the chances of having another are high, but a new report shows many patients aren't getting the interventions they need to reduce that risk.

Those interventions include lifestyle changes, such as smoking cessation and exercise, and medical treatments, such as aspirin, blood pressure medications and cholesterol-lowering drugs.

"The overall use of many services was suboptimal, predominantly in the 60 to 80 percent range, where ideal would be that 100 percent received each item of care we examined," said lead researcher Dr. Joseph S. Ross, a professor of geriatrics and adult development at Mount Sinai School of Medicine in New York City. "However, when we examined whether there were age, sex or racial disparities in care, we found none."

"We need to do a better job of ensuring that adults who have had a stroke receive all appropriate and recommended care in the ambulatory setting in order to prevent subsequent strokes or other problems from developing," he added.

The report was published in the March 5 online edition of Stroke.

For the study, Ross' group collected data on 11,862 men and women who had had a stroke. The researchers evaluated the use of 11 stroke prevention services taking aspirin, exercising, cholesterol reduction, managing high blood pressure, managing diabetes and preventing infectious diseases.

The researchers found that only 31 percent of the patients had rehab services. In addition, 57 percent exercised regularly, 77 percent took aspirin regularly, 66 percent had counseling to quit smoking, 62 percent of those with high blood pressure received dietary counseling, 91 percent of those with high blood pressure were taking antihypertensive medications, 89 percent of those with diabetes reported annual testing for average blood sugar, 52 percent had flu vaccinations and 53 percent received pneumococcal vaccinations.

When Ross' team looked at racial, age or gender disparities in secondary stroke prevention they didn't find any. Some 90 percent of the patients had health insurance and a regular health-care provider.

Moreover, there was no significant difference in care among patients living in the so-called Stroke Belt (Alabama, Arkansas, Georgia, Indiana, Kentucky, Louisiana, Mississippi, North Carolina, South Carolina, Tennessee, or Virginia.).

Also, 13 percent were black, a group traditionally identified as at higher risk for stroke.

"Strategies are needed to improve stroke secondary prevention, such as increasing regular activity/exercise and better dietary and tobacco cessation counseling, and these strategies need to focus on all adults, as there are not segments of the population whose care is far worse than another's," Ross said.

Dr. Larry B. Goldstein, director of the Duke Stroke Center at Duke University Medical Center, said that because the study relied on patients' own reports, it may not accurately represent the actual care they received.

"It needs to be understood that patient-reported care may or may not reflect actual care," Goldstein said.

"For example, patients who smoke might not be willing to admit that they were told to quit. They may not realize or remember what tests they may have received. Medicines other than aspirin may be used for secondary stroke prevention that apparently were not included in the survey. Not all stroke patients require outpatient rehabilitation," he said.

More information

For more about stroke, visit the U.S. National Library of Medicine.

SOURCES: Joseph S. Ross, M.D., M.H.S., professor, geriatrics and adult development, Mount Sinai School of Medicine, New York City; Larry B. Goldstein, M.D., professor, neurology, and director, Duke Stroke Center, Duke University Medical Center, Durham, N.C.; March 5, 2009, Stroke, online

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