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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