The association of a streamlined and updated stroke protocol with improved secondary prevention and outcome

Abstract

AbstractBackgroundStroke recurrence rates following an index event remain high compared with the baseline population. Evidence-based stroke treatments reduce this risk.AimsTo determine the effect of an updated and streamlined hospital stroke guideline on prescribing practices and stroke recurrence rates at 3 months.MethodsHospital registries were searched for ICD-10 codes for transient ischaemic attack (TIA) and ischaemic stroke between July 2019 and July 2020. Data on patient demographics, discharge documentation, and other outcomes of interest were dichotomised into pre and post-intervention.Results396 patients were identified. There was a significant reduction in the stroke recurrence rate at 3 months post guideline update (8.3% vs 2.2%, OR 0.24, p<0.01). There were significant improvements in prescriptions for statins (66.5% vs 81.2%, p≤0.01) and antihypertensives (40.7% vs 50.7%, p=0.05), and documentation of lipid and blood pressure targets in discharge letters. There was a trend towards greater use of dual antiplatelet therapy (25.2% vs 34.1%, p=0.057).ConclusionIn this audit, we found an association between the guideline update and improved patient outcomes and prescribing practices. We were unable to directly attribute the reduction in stroke recurrence to any single factor. This may be a chance finding and warrants investigation in other settings.