Study highlights:
• Only 50 percent to 70 percent of prevention services to avert a second stroke are generally used.
• The poor rates were noted across races, gender and age.
• Researchers suggest physicians focus on improving care for all stroke patients to boost the level of care.

DALLAS, March 5, 2009 — Men and women who have experienced a first stroke report sub-optimal use of healthcare services to prevent a second stroke, researchers reported in Stroke: Journal of the American Heart Association.

“Alarmingly high numbers of adults did not receive stroke prevention services,” said Joseph S. Ross, M.D., M.H.S., the study’s principal author and assistant professor in the department of geriatrics and adult development at Mount Sinai School of Medicine in New York City. “Most usage rates for prevention services were between 50 percent and 70 percent,” he said. “That’s a lot of people not getting recommended care.”

Researchers analyzed the use of key secondary prevention services, based on the nationally representative 2005 Behavior Risk Factor Surveillance System (BRFSS), conducted by the Centers for Disease Control and Prevention (CDC).

The study included 11,862 adults ages 18 years and older (54 percent women) who reported ever having had a stroke. The study examined use of 11 stroke secondary prevention services and found use varied widely.

The outpatient measures included:
• vascular risk reduction, such as taking aspirin regularly, exercising regularly and annual cholesterol testing and management;
• management of high blood pressure;
• management of diabetes; and
• infectious disease prevention.

The study found:
• 31 percent of patients received outpatient rehabilitation services;
• 52 percent reported influenza vaccination and 53 percent received pneumococcal vaccination;
• 57 percent exercised regularly;
• 77 percent used aspirin regularly;
• 66 percent received counseling to quit smoking;
• 62 percent with high blood pressure received low-fat diet counseling;
• 91 percent with high blood pressure reported currently taking hypertensive medication; and
• 89 percent of those with diabetes reported having annual glycosylated hemoglobin measurements for diabetes management. This measures the amount of sugar attached to the hemoglobin in red blood cells and shows the average blood sugar for several months before and can help regulate diabetic behavior.

“Suboptimal care has important implications for the care of adults who have had a stroke,” Ross said. “Regular exercise, reported by 57 percent in our study, is among the most straightforward stroke prevention strategies, even if limited to modest, leisure-time physical activity. It needs to be prioritized for counseling by primary care physicians and neurologists.”

In another aspect of the study, researchers analyzed potential disparities in use of these secondary prevention services, based on race, age, gender or geographic residence:

About 90 percent of the survey participants had health insurance coverage and had a regular healthcare provider.

The study found no significant differences in possible disparities, even though nearly one-quarter of the post-stroke adults lived in a Stroke Belt state (Alabama, Arkansas, Georgia, Indiana, Kentucky, Louisiana, Mississippi, North Carolina, South Carolina, Tennessee, or Virginia.), and 13 percent were non-Hispanic blacks, groups traditionally identified as at higher risk.

“We were surprised not to find any consistent disparities,” Ross said. “It’s probably because once people have had a stroke, they are in the medical system.”

Ross noted the healthcare services highlighted in this study have been recommended by the American Heart Association/American Stroke Association, based on scientific evidence.

“In the future, improving secondary prevention services means we need to focus on everybody, since it is not possible to focus on one particular group to lift up the level of care,” Ross said.

Co-authors are: Ethan A. Halm, M.D., M.P.H. and Dawn M. Bravata, M.D. Individual author disclosures can be found on the manuscript. No external funding was used for this research.

Editor’s note: For more information on stroke, visit the American Stroke Association Web site: www.strokeassociation.org.

Statements and conclusions of study authors that are published in American Heart Association scientific journals are solely those of the study authors and do not necessarily reflect the association’s policy or position. The association makes no representation or guarantee as to their accuracy or reliability. The association receives funding primarily from individuals; foundations and corporations (including pharmaceutical, device manufacturers and other companies) also make donations and fund specific association programs and events. The association has strict policies to prevent these relationships from influencing the science content. Revenues received from pharmaceutical and device corporations are available at www.americanheart.org/corporatefunding.  

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NR09-1039 (Stroke/Ross)