Risk Factor Management with Guideline-Based Medications for Prevention of Recurrent Ischemic Stroke: A Retrospective Chart Review

Background: Implementation of new practice guidelines for stroke prevention has decreased the number of patients experiencing recurrent stroke. Clinical trials show antihypertensives, high-intensity statins, and antithrombotics to be beneficial after stroke. Objective: The objective of this study was to determine if recurrent stroke patients were discharged on guideline-based medications for secondary stroke prevention, and to identify potential errors in appropriate prescribing of medications. Methods: A retrospective chart review was conducted at a community hospital and included patients 19 years and older diagnosed with their second, third, or fourth stroke (transient ischemic attack or cerebrovascular accident). Descriptive statistics were used to describe collected information. Collected data included relevant patient demographics, diagnosis, past medical history, medications, and readmission rates. The primary objective was the percentage of patients appropriately discharged on guideline-based secondary stroke prevention medications. Appropriate treatment was based upon the 2010 and 2014 American Heart Association/American Stroke Association Guidelines for the Prevention of Stroke in Patients with Stroke and Transient Ischemic Attack. Results: A total of 124 charts were reviewed, 106 charts met the inclusion criteria. Guideline-based and appropriate medication-use was initiated in 9% and 4% of patients with noncardioembolic and cardioembolic stroke, respectively. Therapy deemed not guideline-based, but appropriate was initiated in 20% and 9% of patients with noncardioembolic and cardioembolic stroke, respectively. Errors in appropriate prescribing of secondary prevention medications were related to statins and antihypertensives. Conclusion: Better adherence to preventative recurrent stroke measures is needed at the time of patient discharge.