Preventive Care

Women and blacks are less likely to receive preventive care to prevent further strokes

A third of stroke survivors suffer another stroke within 5 years. There are several measures clinicians can take to reduce the risk of another stroke in these patients, but women and blacks are less likely to receive them, according to a new study. This is a problem especially for blacks who, along with Hispanics, are at greater risk for recurrent stroke than whites. The researchers examined the patient charts of stroke victims at four urban hospitals for completeness of diagnostic evaluation, discharge treatment regimen, and antihypertensive, lipid-lowering and antithrombotic medication use (to prevent blood clots that can cause strokes) at 6 months after hospital discharge.

Of the 501 patients hospitalized for acute ischemic stroke, nearly all of them received electrocardiograms and brain imaging, 75 percent had carotid artery evaluations, and 70 percent had serum lipid levels tested. Overall, 54 percent of whites, 62 percent of Hispanics, and 77 percent of blacks received incomplete inpatient evaluations. Similarly, 54 percent of men, but 66 percent of women had incomplete inpatient evaluations. In addition, 40 percent of whites and 43 percent of Hispanics, but 59 percent of blacks received inadequate discharge regimens of anticoagulant, antihypertensive, and lipid-lowering medications. Also, 33 percent of whites and 37 percent of Hispanics, but only 18 percent of blacks received adequate outpatient follow-up. Six months after their initial stroke, blacks (81.6 percent) were more likely to have received insufficient preventive measures than Hispanics (62.5 percent) or whites (66.7 percent). Women were more likely to receive incomplete in-hospital evaluations as well as discharge regimens.

Improving delivery of these effective interventions will reduce recurrent stroke risk and may reduce stroke risk disparities among minorities, conclude the researchers. Their study was supported in part by the Agency for Healthcare Research and Quality (HS10859).

See "The association of race and sex with the underuse of stroke prevention measures," by Stanley Tuhrim, M.D., Alice Cooperman, M.P.H., Mary Rojas, Ph.D., and others, in the July-August 2008 Journal of Stroke and Cerebrovascular Diseases 17(4), pp. 226-234.

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