Doctors do not treat risk factors for stroke as they should

Despite significant improvements in stroke prevention over the last decade and a decline in deaths, UK doctors are not treating it as a need of major risk factors, atrial fibrillation and abnormal heart rhythm.

The discovery is based on analysis of data on stroke originating from the General Practice Research Database (GPRD) for the period 1999 to 2008. The GPRD contains anonymous data about long-term three million patients in UK primary care.

More than 32 000 adults had a stroke and 15% were fatal, during the study period.

Women were more likely to die from stroke than men, even after taking age into account. The average age for a first stroke was 77 years for women and 71 years for men.

The figures showed improvements in the number of cases and subsequent survival.

The prevalence of stroke increased by 12.5%, but the number of new cases fell by almost a third (30%) in the decade from 1.48 per 1,000 people per year in 1999 to 1.04 in 2008.

Among those 80 years or older, who are at increased risk of stroke, the decline was even greater, 42%.

The rate of deaths within 56 days after a first stroke fell by almost half, from 21% in 1999 to about 12% in 2008.

These improvements occurred with an increase in the number of prescriptions for preventive medications, particularly those used to lower cholesterol and high blood pressure, both risk factors for stroke.

But doctors treated patients required below with atrial fibrillation, according to the findings.

About 1 in 10 patients were diagnosed with atrial fibrillation before the first stroke, and this group was much more at risk of dying from stroke than those without atrial fibrillation.

Only one of four individuals with atrial fibrillation received prescriptions for treatment with blood-thinning anti-coagulant preventive, without any sign of a more serious atrial fibrillation were being attacked.

Women, despite having more chances of having a serious atrial fibrillation, received less prescriptions for anti-coagulant therapy. They were prescribed for 29% of men with atrial fibrillation and only 22% of women.

Both men and women with atrial fibrillation were more likely to receive prescriptions for anticoagulants after a first stroke, but as the numbers grew from 29% to 48% in men rose from 22% to 35% in women.

The authors conclude that primary care physicians are treating the risk factors for stroke in a much more effective. "However, there is a clear suggestion that risk stratification is still not ideal, especially for those patients with atrial fibrillation," they wrote.

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