Cardiology Research, ISSN 1923-2829 print, 1923-2837 online, Open Access
Article copyright, the authors; Journal compilation copyright, Cardiol Res and Elmer Press Inc
Journal website https://www.cardiologyres.org

Original Article

Volume 14, Number 4, August 2023, pages 302-308

Evaluation of Physicians’ Compliance With Secondary Prevention Among Ischemic Stroke Patients: A Retrospective Study

Figure

Figure 1.
Figure 1. Flowchart of patients admitted to the stroke unit. Others were patients who were suspected of having IS or TIA but without any confirmed medical diagnosis. DAMA: discharged against medical advice; IS: ischemic stroke; N: number; TIA: transient ischemic attack.

Tables

Table 1. Recommended Secondary Prevention Medications for Ischemic Stroke per AHA/ASA Guideline
 
Class of medicationRecommendation
Manage other comorbidities that increase the risk of stroke if existing, such as HTN, DM, AF and smoking. AF: atrial fibrillation; AHA/ASA: American Heart Association/American Stroke Association; AV: aortic valve; DM: diabetes mellitus; DOACs: direct oral anticoagulants; HTN: hypertension; LMWH: low molecular weight heparin; LV: left atrial myopathy; NVAF: non-valvular atrial fibrillation; VAF: valvular atrial fibrillation.
AntiplateletAspirin or clopidogrel as alternative
AnticoagulationWarfarin heparin or LMWH for: VAF, AV, LV, congenital heart disease
DOACs for: NVAF
StatinsHigh-intensity statin

 

Table 2. Patients’ Demographic Characteristics
 
Characteristicsn (%)
aOne stroke event: 150 patients; 2 - 4 stroke events: 30 patients; more than five stroke events: one patient. IQR: interquartile range; SD: standard deviation.
Age, years
  Mean ± SD59.5 ± 15.6
  Median (IQR)60 (19 - 107)
Gender
  Male318 (62.1)
  Female189 (37.9)
Body mass index (mean), kg/m230.3
Smoker90 (17.8)
Former smoker64 (12.6)
Obesity191 (37.7)
Chronic kidney disease42 (8.3)
Past medical history
  Hypertension389 (76.7)
  Diabetes mellitus311 (61.3)
  Dyslipidemia124 (24.5)
  Atrial fibrillation49 (9.7)
  Seizure patient73 (14.4)
  Ischemic heart disease129 (25.4)
  Stroke181a (35.7)

 

Table 3. Number of Patients Discharged on Medications to Manage Comorbidities (Diagnosed During Admission)
 
ComorbiditiesHTNDMAF
AF: atrial fibrillation; DM: diabetes mellitus; HTN: hypertension.
Number of patients newly diagnosed comorbidities during admission12813
Number of patients discharged with appropriate medication11 (91.6%)8 (100%)10 (80%)

 

Table 4. Number of Patients Discharged on Medications to Manage Comorbidities (Past Medical History)
 
ComorbiditiesHTNDMDyslipidemiaAFSmokers
Number of patients with history of comorbidities who did not discharge on appropriate medications = a - b. AF: atrial fibrillation; DM: diabetes mellitus; HTN: hypertension.
Number of patients with past medical history (a)3983111244990
Number of patients discharged with appropriate medication (b)3672751244120

 

Table 5. Total Number of All Patients Discharged on Complete Ischemic Stroke Secondary Prevention
 
AF: atrial fibrillation; DAPT: dual antiplatelet therapy; DOAC: direct oral anticoagulant; LMWH: low molecular weight heparin.
Antiplatelet therapy409 (80.7%)
  Aspirin178 (43.7%)
  Clopidogrel49 (12.04%)
  DAPT182 (44.7%)
Anticoagulant (for AF)146 (28.8%)
  Warfarin, heparin or LMWH67 (45.9%)
  DOAC79 (54.1)
Statins469 (92.5%)
  Antihypertensive medication378
  Antidiabetic medication283
  Atrial fibrillation medication51
  Nicotine replacement therapy20
Number of patients discharged with all secondary prevention medication when appropriate376 (74%)