STROKE PREVENTION IN PRIMARY CARE

Introduction Stroke is a major burden in the UK, costing around £7 billion per year. Eliminating modifiable risk factors is the most effective way to reduce the incidence of stroke. It is widely accepted that factors deserving the most comprehensive treatment are: hypertension, diabetes mellitus, hyperlipidaemia, smoking and cardiac disease (such as atrial fibrillation). Methods I assessed the health care needs of a semi-rural primary care practice covering 3280 patients. The study population were those patients at an increased risk of stroke. National guidelines on ‘optimal uptake’ of preventative medications have been compared to uptake in the study group. Deficiencies highlighted in the first stage of analysis have allowed estimates for the incidence of preventable strokes. Results 73% of the study population have untreated or inadequately treated hypertension and 45% are not receiving antiplatelet or anticoagulation therapy despite their atrial fibrillation. The most profound result however, is the 45% not taking aspirin or warfarin despite a history of stroke. Tighter control of blood pressure could prevent >2 strokes per year in the study population. Aspirin therapy in patients with cardiac disease or a history of stroke could prevent a further 12.5 and 15 strokes per year, respectively. Extrapolation to the population at large indicates an unmet need for risk factor reduction in high-risk groups. Conclusion This study has highlighted targets for immediate change. With focused primary intervention strategies these results can be improved. Despite the additional cost of treatment, prevention of stroke is the most effective way to address areas of unmet need and ultimately reduce the long-term health burden.