December 7th 2016

Approximately 12,000 first strokes could be prevented through optimal drug prescribing.

New findings suggest medications that help reduce the chance of a stroke may be underused, and through the optimal prescribing of these drugs, about 12,000 first strokes in the UK each year could be prevented.

It’s recommend that patients with high blood pressure take medications to lower it, while high-risk patients with cardiovascular disease (CVD), or at high risk of CVD, should be prescribed a statin.

In a study published inPLOSMedicine, researchers examined electronic medical records from more than 500 general practices, and identified patients who suffered a first stroke or transient ischaemic attack (TIA) between January 2009 and December 2013.

Patients who were known to be at high-risk because of blood pressure, with CVD or at high risk of CVD, and/or atrial fibrillation before the stroke were identified.

The results of the study showed there were 29,043 patients with first stroke or TIA, of whom, 17,680 should have been prescribed astatin, or drugs that lower blood pressure or prevent blood clots. Furthermore, more than half of those individuals were not prescribed these drugs, but should have been.

In 54% of stroke/TIA patients, at least 1 prevention drug was not prescribed when clinically indicated. There were 42% of patients with atrial fibrillation who were not prescribed anticoagulant drugs to prevent blood clots, 49% who were high risk but were not prescribed statins, and 25% of patients with high blood pressure who were not prescribed antihypertensive drugs to lower their blood pressure.

Researchers found that between 2009 and 2013, there was no significant reduction in the proportion of stroke/TIA patients with prior missed opportunities for prevention with lipid lowering or antihypertensive drugs, according to the study. However, there were improvements seen in prescribing anticoagulant drugs during this period.

“These findings suggest a number of missed opportunities to reduce the incidence of strokes,” said researcher Dr Grace Turner. “The next step for us is to build on this exploratory study and investigate the reasons for under-prescribing, with a view to developing an intervention that can help to bridge the gap.

“It’s worth noting that there are instances where not prescribing may be the correct approach. For example, there are elderly patients who may be frail and have multiple significant comorbidities who wouldn’t be suitable, and there are patients who actively take part in the decision to not prescribe.”

A limitation to the study is that it only looked at prescribed drugs, and not all patients who are prescribed drugs take them. Furthermore, they may not be taking enough to get their blood pressure under control. The authors noted that if anything, this means there are more patients who are undertreated than what this study suggests.

“We’re fortunate to have a wealth of patient data available to us in the UK which, if analyzed appropriately, can provide valuable information to inform new guidelines and practices that will improve primary care provision,” said Mel Calvert, director of the Center for Patient Reported Outcome Research.

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