Christian Boehme1, Thomas Toell1, Lukas Mayer-Suess1, Lena Domig1, Raimund Pechlaner1, Karin Willeit2, Lena Tschiderer1, Lisa Seekircher1, Peter Willeit2, Andrea Griesmacher1, Michael Knoflach1, Johann Willeit2, Stefan Kiechl2. 1. From the Department of Neurology (C.B., T.T., L.M., L.D., R.P., K.W., L.T., L.S., P.W., M.K., J.W., S.K.), Medical University of Innsbruck, Austria; Department of Neurology (K.W.), Inselspital, University Hospital of Bern, Switzerland; Department of Public Health and Primary Care (P.W.), University of Cambridge, UK; and Central Institute for Medical and Chemical Laboratory Diagnosis (A.G.), Medical University of Innsbruck, Austria. 2. From the Department of Neurology (C.B., T.T., L.M., L.D., R.P., K.W., L.T., L.S., P.W., M.K., J.W., S.K.), Medical University of Innsbruck, Austria; Department of Neurology (K.W.), Inselspital, University Hospital of Bern, Switzerland; Department of Public Health and Primary Care (P.W.), University of Cambridge, UK; and Central Institute for Medical and Chemical Laboratory Diagnosis (A.G.), Medical University of Innsbruck, Austria. stefan.kiechl@i-med.ac.at johann.willeit@i-med.ac.at.
Abstract
OBJECTIVE: To analyze the frequency of inadequately treated risk factors in a large representative cohort of patients with acute ischemic stroke or TIA and to estimate the proportion of events potentially avertable by guideline-compliant preventive therapy compared to the status quo. METHODS: A total of 1,730 patients from the Poststroke Disease Management STROKE-CARD trial (NCT02156778) were recruited between 2014 and 2017. We focused on 8 risk conditions amenable to drug therapy and 3 lifestyle risk behaviors and assessed pre-event risk factor control in retrospect. RESULTS: The proportion of patients with at least 1 inadequately treated risk condition was 79.5% (95% confidence interval [CI] 77.6%-81.4%) and increased to 95.1% (95% CI 94.1%-96.1%) upon consideration of the lifestyle risk behaviors. Risk factor control was worse in patients with recurrent vs first-ever events (p < 0.001), men vs women (p = 0.003), and patients ≤75 vs >75 years of age (p < 0.001). The estimated degree of stroke preventability ranged from 0.4% (95% CI 0.2%-0.6%) to 13.7% (95% CI 12.2%-15.2%) for the individual risk factors. Adequate control of the 5 most relevant risk factors combined (hypertension, hypercholesterolemia, atrial fibrillation, smoking, and overweight) would have averted ≈1 of 2 events or 1 in 4 with a highly conservative computation approach. CONCLUSIONS: Our study confirms the existence of a considerable gap between risk factor control recommended by guidelines and real-world stroke prevention. Our study intends to increase awareness among physicians about stroke preventability and provides a quantitative basis for the emerging discussion on how to best tackle this challenge.
OBJECTIVE: To analyze the frequency of inadequately treated risk factors in a large representative cohort of patients with acute ischemic stroke or TIA and to estimate the proportion of events potentially avertable by guideline-compliant preventive therapy compared to the status quo. METHODS: A total of 1,730 patients from the Poststroke Disease Management STROKE-CARD trial (NCT02156778) were recruited between 2014 and 2017. We focused on 8 risk conditions amenable to drug therapy and 3 lifestyle risk behaviors and assessed pre-event risk factor control in retrospect. RESULTS: The proportion of patients with at least 1 inadequately treated risk condition was 79.5% (95% confidence interval [CI] 77.6%-81.4%) and increased to 95.1% (95% CI 94.1%-96.1%) upon consideration of the lifestyle risk behaviors. Risk factor control was worse in patients with recurrent vs first-ever events (p < 0.001), men vs women (p = 0.003), and patients ≤75 vs >75 years of age (p < 0.001). The estimated degree of stroke preventability ranged from 0.4% (95% CI 0.2%-0.6%) to 13.7% (95% CI 12.2%-15.2%) for the individual risk factors. Adequate control of the 5 most relevant risk factors combined (hypertension, hypercholesterolemia, atrial fibrillation, smoking, and overweight) would have averted ≈1 of 2 events or 1 in 4 with a highly conservative computation approach. CONCLUSIONS: Our study confirms the existence of a considerable gap between risk factor control recommended by guidelines and real-world stroke prevention. Our study intends to increase awareness among physicians about stroke preventability and provides a quantitative basis for the emerging discussion on how to best tackle this challenge.
Authors: Felizitas A Eichner; Christopher J Schwarzbach; Moritz Keller; Karl Georg Haeusler; Gerhard F Hamann; Dirk Sander; Heinrich J Audebert; Klaus Gröschel; Dieter Geis; Stephan von Bandemer; Viktoria Rücker; Martha Schutzmeier; Peter Ulrich Heuschmann; Armin Grau Journal: Eur Stroke J Date: 2020-03-12
Authors: Christian Boehme; Lena Domig; Silvia Komarek; Thomas Toell; Lukas Mayer; Benjamin Dejakum; Stefan Krebs; Raimund Pechlaner; Alexandra Bernegger; Christoph Mueller; Gerhard Rumpold; Andrea Griesmacher; Marion Vigl; Gudrun Schoenherr; Christoph Schmidauer; Julia Ferrari; Wilfried Lang; Michael Knoflach; Stefan Kiechl Journal: BMC Cardiovasc Disord Date: 2022-08-01 Impact factor: 2.174
Authors: Viktoria Fruhwirth; Lisa Berger; Thomas Gattringer; Simon Fandler-Höfler; Markus Kneihsl; Andreas Schwerdtfeger; Elisabeth Margarete Weiss; Christian Enzinger; Daniela Pinter Journal: Front Neurol Date: 2022-01-05 Impact factor: 4.003