Stroke prevention opportunities are being lost, study shows
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《英国医生杂志》
Major opportunities are being missed for the prevention of stroke, and services need reorganising to prevent unnecessary deaths, according to the largest audit of stroke prevention carried out in the United Kingdom.
Six months after their stroke a high proportion of patients were without appropriate treatment or had risk factors that were uncontrolled, say the authors of a study in Age and Ageing (2004;33:280-6).
揗ajor deficiencies in delivery of secondary prevention after stroke have been demonstrated. Services need reorganisation to prevent unnecessary mortality and morbidity in this group of patients. It is time investment was made both in terms of research and service delivery to transform services in the United Kingdom,?say the authors.
They warn that secondary prevention for stroke is an area of care that may be suffering from the split in the United Kingdom between primary and secondary care, 搘ith neither party taking responsibility on the assumption that the other is doing it.?/p>
In the study of the secondary treatment of stroke, the authors, from the clinical effectiveness and evaluation unit of the Royal College of Physicians, analysed data provided by 235 hospitals on 40 consecutive patients admitted for stroke. Each year around 130 000 cases of stroke occur in the United Kingdom, and between 10% and 15% of these patients will have a recurrence within one year and 30% within five years.
The results show that 24% of patients with previous cerebrovascular disease were not taking antithrombotic drugs at the time of their admission and that almost one in 10 patients for whom treatment would be appropriate were not taking antithrombotics at discharge.
Some 64% of patients had lipids measured during their hospital stay; and of the patients with a high total cholesterol concentration 36% were not taking lipid lowering drugs. Patients aged over 75 years were less likely to be treated than patients aged under 65.
揅learly there are major opportunities being missed in both primary and secondary stroke prevention. From previous national audit data it would appear as if little has changed over the last four years, despite the statements of good intent from central government,?the authors said.
Too many patients are suffering strokes, with known risk factors untreated, and there are evidently systematic problems in delivering effective universal prevention after stroke, both within the hospital and in primary care.
揙lder patients, particularly those over the age of 75 years and those with more severe disability after stroke, are less likely to receive appropriate secondary prevention, and it is these groups that need to be specifically targeted in health promotion strategies.?/p>
The authors add, 揑t is hoped that introduction of targets for secondary prevention in the new general medical services contract may focus attention on the delivery of high quality services for all patients.?/p>(Abergavenny, Roger Dobson)
Six months after their stroke a high proportion of patients were without appropriate treatment or had risk factors that were uncontrolled, say the authors of a study in Age and Ageing (2004;33:280-6).
揗ajor deficiencies in delivery of secondary prevention after stroke have been demonstrated. Services need reorganisation to prevent unnecessary mortality and morbidity in this group of patients. It is time investment was made both in terms of research and service delivery to transform services in the United Kingdom,?say the authors.
They warn that secondary prevention for stroke is an area of care that may be suffering from the split in the United Kingdom between primary and secondary care, 搘ith neither party taking responsibility on the assumption that the other is doing it.?/p>
In the study of the secondary treatment of stroke, the authors, from the clinical effectiveness and evaluation unit of the Royal College of Physicians, analysed data provided by 235 hospitals on 40 consecutive patients admitted for stroke. Each year around 130 000 cases of stroke occur in the United Kingdom, and between 10% and 15% of these patients will have a recurrence within one year and 30% within five years.
The results show that 24% of patients with previous cerebrovascular disease were not taking antithrombotic drugs at the time of their admission and that almost one in 10 patients for whom treatment would be appropriate were not taking antithrombotics at discharge.
Some 64% of patients had lipids measured during their hospital stay; and of the patients with a high total cholesterol concentration 36% were not taking lipid lowering drugs. Patients aged over 75 years were less likely to be treated than patients aged under 65.
揅learly there are major opportunities being missed in both primary and secondary stroke prevention. From previous national audit data it would appear as if little has changed over the last four years, despite the statements of good intent from central government,?the authors said.
Too many patients are suffering strokes, with known risk factors untreated, and there are evidently systematic problems in delivering effective universal prevention after stroke, both within the hospital and in primary care.
揙lder patients, particularly those over the age of 75 years and those with more severe disability after stroke, are less likely to receive appropriate secondary prevention, and it is these groups that need to be specifically targeted in health promotion strategies.?/p>
The authors add, 揑t is hoped that introduction of targets for secondary prevention in the new general medical services contract may focus attention on the delivery of high quality services for all patients.?/p>(Abergavenny, Roger Dobson)