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GPs urged to prescribe more preventative drugs for stroke patients

Approximately one third of stroke and mini-stroke (TIA) patients could be missing out on preventative drugs, a study has claimed.

Researchers at the University of Birmingham looked at GP medical records for 29,043 patients who had experienced a first stroke or TIA between 2009 and 2013.

Six in ten of these patients had clinical indicators that they should have been prescribed an anticoagulant, antihypertensive or statin. However, approximately half of these did not receive prescriptions, meaning that a third of the patient group missed out on preventative drugs.

According to the researchers, extrapolation of this data could mean that about 12,000 people are experiencing a preventable first stroke each year in the UK due to sub-optimal prescribing by GPs.

In patients who were not prescribed at least one preventative drug when clinically indicated, under-prescription occurred in:

  • 52% of those with an indication for anticoagulants
  • 49% of those with an indication for statins
  • 25% of those with an indication for antihypertensives

During the study period, under-prescription of anticoagulants improved slightly, most likely, the researchers suggest, due to the introduction of QOF incentives for anticoagulant prescription for patients with atrial fibrillation between 2009 and 2013, but no improvements were seen for antihypertensives or statins.

The researchers suggest that these findings have important ramifications for clinical guidance.

‘Substantial numbers of strokes and TIAs could potentially be prevented through improving prescription of these drugs in primary care, which would contribute to reducing the burden of these conditions,’ they said.

Dr Chris Arden, GPSI in cardiology in Southampton, says that these findings reinforce the fact that GPs are missing many opportunities for early prevention of stroke.

He said: ‘I’d like to think that prescription rates have improved since 2013. There’s been a lot of work done with atrial fibrillation patients in particular, and we’ve seen a reduction in the number of strokes in our local area because of this. There is still a lot of work to do, particularly in hypertension, to make sure that patients at high risk are being managed more intensively.

‘This data is important as it will help GPs to make patients more aware of the risk involved with these conditions and aid joint decisions between doctor and patient when it comes to prescribing.’

PLOS Medicine 15 November 2016

http://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1002169#sec015

Readers' comments (12)

  • Practically all of these patients will have been seen in secondary care. So why was appropriate treatment not instigated there?

    Why is it always the GPs job to check on secondary care work, when they are funded at a far higher level. What is more, we are even financially penalised for many of their mistakes through QoF. What about financially penalising secondary care?

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  • Sound so like a field day for the lawyers!!

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  • Not sure how cialis and levitra will help!

    (current picture attached to this article is a pile of drugs for ED)

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  • Well spotted. The pic was supposed to signify drugs that could - very indirectly - lead to CVD.

    Either that, or it was an error on our part...

  • Vinci Ho

    One of the problems throughout the years was some common consensus amongst researchers on a standardised 'cocktail' for secondary prevention of Stroke/TIA , as seen in post MI , considering some similarities in pathology with endothelial dysfunction . PROGRESS study advocated a combination of perindopril and indapamide and keeping BP as low as possible but is often limited by risk of postural hypotension especially in little old ladies . Aspirin versus clopidogrel in patients in sinus rhythm went on a while before the latter established its position . It took a while before people concluded when to anticoagulate AF after two versions of CHADS score.Drug like Persantin(Dipyridamole) was phased out. Statin should be there but there was some unnecessary concern years ago about haemorrhage related to lowering cholesterol too much .
    GPs are dealing with patients discharged from secondary care at different time points in this history of how to treat post TIA/Stroke patients.

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  • You don't prevent strokes and TIAs at all, you postpone them and the sooner the public, media and politicians realise this the better. When stock on my farm sit in their own excrement and can't feed themselves I don't fit nappies and a PEG, I call the vet. Just glad I walked away last year aged 49yrs, it's too mad for me. Good luck to all who remain.

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  • John Glasspool

    Levitra eh? To prevent strokes. I guess it depends on who you want to stroke you? (And where?)

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  • I don't know if any of you readers caught the newsflash that ,apparently, we are all going to die one day.

    The comment above about nappies and PEGs was interesting;reminds me of the phrase 'All roads lead to Rome' with stroke and dementia being 2 of the widest highways.

    The pics of stiffy-pills should not be dismissed out 'of hand'; the role of post-stroke physiotherapy is so poorly financed that anything which can serve as an incentive to get that hand working (for males) may yield benefits, beyond a sticky mess in ones lap.

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  • The lawyers must be rubbing their hands together in glee. Don;t be a GP, endless responsibility without adequate funding

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  • How does this gel with NICE poly pharmacy guidance. We are always being pulled
    In different directions.

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  • Please tell me they looked at dissent codes?

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