Secondary Prevention Gaps at Recurrent Ischemic Stroke Admission: A Nationwide Registry Study

Q: What are the key findings of this study?

Between 2018 and 2023, pre-admission antithrombotic therapy use among recurrent ischemic stroke patients increased from 74.6% to 79.4% (OR 1.05 per year) but plateaued after 2019.

Q: What is the clinical evidence from this study?

Study design: Observational. Population: Recurrent ischemic stroke (n=24183). Intervention: Calendar year progression (temporal trend) vs. Earlier calendar years (e.g., 2018). Primary outcome: Pre-admission antithrombotic therapy use (OR 1.05 per year, 95% CI 1.01-1.09, p=0.027).

Q: What does this research mean for the field?

Persistent and unevenly distributed gaps in secondary prevention persist among patients admitted with recurrent ischemic stroke, with substantial proportions remaining untreated with antithrombotics, oral anticoagulants for atrial fibrillation, or adequate lipid-lowering therapy. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Eung‐Joon Lee; Matthew J. Chung; Han‐Yeong Jeong; Jayoun Kim; Nan Hee Park; Min Kyoung Kang; D. Lee; Jinkwon Kim; Yo Han Jung; Sungwook Yu; Wook-Joo Kim; Han-Jin Cho; Kyungbok Lee; Tai Hwan Park; Mi Sun Oh; Ji Sung Lee; Joon-Tae Kim; Byung Woo Yoon; Jong-Moo Park; Hee‐Joon Bae; Keun‐Hwa Jung

doi:10.5853/jos.2026.02761

Key result

Pre-admission antithrombotic use in recurrent stroke rises ~5% higher per year, plateauing after 2019.

OR 1.05 per year
95% CI 1.01-1.09
P=0.027
n=24,183

Why the study?

Recurrent ischemic stroke admissions provide a critical opportunity to assess secondary prevention delivery and identify gaps in care.

Key Points

To quantify the attainment of guideline-recommended secondary prevention indicators, examine age- and sex-related variations, and estimate potentially preventable recurrent ischemic strokes.
Analyzed 24,183 recurrent ischemic stroke admissions across 81 Korean Stroke Registry hospitals between 2018 and 2023.
Evaluated five secondary prevention indicators: antithrombotic therapy use, LDL-C <70 mg/dL, HbA1c <7.0% in diabetes, non-current smoking, and normal weight (BMI 18.5–24.9 kg/m²).
Modeled temporal trends using hospital-clustered generalized estimating equation logistic regression and projected preventable recurrent events using trial-derived relative risk reductions.
Antithrombotic therapy use increased from 74.6% to 79.4% (OR/year 1.05, 95% CI 1.01–1.09) but plateaued after 2019, leaving 20.6% untreated in 2023; oral anticoagulant use in known atrial fibrillation rose from 65.3% to 73.3% (OR/year 1.08; P=0.005), leaving 26.7% untreated.
LDL-C <70 mg/dL attainment increased from 32.6% to 41.9% (OR/year 1.08; P<0.001) overall, but did not improve among adults aged 19–49 years, in whom obesity (BMI ≥25 kg/m²) increased from 36.2% to 56.2%.
Case-based projections estimated approximately 183, 126, and 201 potentially preventable recurrent strokes annually within the registry from antithrombotic non-use, oral anticoagulant non-use in atrial fibrillation, and LDL-C control gaps in large-artery atherosclerosis, respectively.

Study Design

Type

Observational (n=24,183)

Multicenter

Yes

Structured PICO

P

Population

24,183 adults aged 19 years and older admitted for recurrent ischemic stroke across 81 Korean Stroke Registry hospitals between 2018 and 2023.

O

Outcome

Annual attainment of secondary prevention indicators: antithrombotic therapy, low-density lipoprotein cholesterol (LDL-C) <70 mg/dL, glycated hemoglobin (HbA1c) <7.0% in diabetes, non-current smoking, and normal weight (BMI 18.5–24.9 kg/m²)

Main Result

Odds Ratio: 1.05 (95% CI 1.01–1.09)

Absolute Event Rate: 79.4% vs 74.6%

p-value: p=0.027

Recurrent stroke admissions highlight persistent secondary prevention gaps, particularly concerning antithrombotic non-use and inadequate LDL-C control, underscoring the need for targeted quality improvement initiatives.

Limitations

Risk-factor status was assessed cross-sectionally at admission rather than longitudinally.
Smoking status relied on self-report, which likely underestimates current smoking, especially in women.
Cross-institutional patient linkage was not feasible due to the absence of a national patient identifier.
Residual misclassification of pre-admission medication use cannot be completely excluded despite database cross-referencing.
Exploratory case-based upper-bound projections assumed direct transfer of trial effect sizes without accounting for competing risks.
Cross-institutional linkage was not feasible because the registry lacks a national patient identifier
Only recurrent stroke cases were observed, rather than the at-risk source population, requiring case-based upper-bound projections rather than population-attributable fractions

Implication

Persistent gaps in antithrombotic and LDL-C control at recurrent stroke warrant implementation efforts; leaves open whether closing them reduces recurrence.

Abstract

Background and Purpose Recurrent ischemic stroke is a sentinel audit point for secondary prevention delivery. We quantified attainment of prevention indicators, sex- and age-related heterogeneity, and projected prevention gains.Methods We analyzed 24,183 recurrent ischemic stroke admissions from 81 Korean Stroke Registry hospitals (2018–2023). Annual attainment of antithrombotic therapy, low-density lipoprotein cholesterol (LDL-C) <70 mg/dL, glycated hemoglobin (HbA1c) <7.0% in diabetes, non-current smoking, and normal weight (body mass index [BMI] 18.5–24.9 kg/m²) was age-standardized descriptively; temporal trends were assessed with hospital-clustered generalized estimating equation models. Projections combined observed implementation gaps with trial-derived relative risk reductions.Results Antithrombotic use increased from 74.6% to 79.4% (odds ratio [OR]/year 1.05, 95% confidence interval 1.01–1.09), but plateaued after 2019, leaving 20.6% untreated in 2023. Among 4,441 patients with known atrial fibrillation (AF), oral anticoagulant use rose from 65.3% to 73.3% (OR/year 1.08; P=0.005), and 26.7% remained untreated. LDL-C <70 mg/dL improved from 32.6% to 41.9% (OR/year 1.08; P<0.001), whereas HbA1c, smoking, and weight indicators showed limited overall progress. Heterogeneity emerged: non-current smoking improved in men but not women (already near ceiling, approximately 95%); LDL-C control did not improve in adults aged 19–49 years; and BMI ≥25 kg/m² rose from 36.2% to 56.2% in this age group. Upper-bound projections estimated approximately 183, 126, and 201 potentially preventable recurrent strokes per year within the registry (not national estimates) from antithrombotic non-use, anticoagulant non-use in AF, and LDL-C gaps in large-artery atherosclerosis, respectively.Conclusions Recurrent-stroke admission revealed persistent, unevenly distributed prevention gaps. Medication reconciliation, AF detection and anticoagulation, lipid intensification, and tailored behavioral pathways should be prioritized.

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Cite This Study

Lee et al. (2026) conducted an observational in Recurrent ischemic stroke (n=24,183). Calendar year progression (temporal trend) vs. Earlier calendar years (e.g., 2018) was evaluated on Pre-admission antithrombotic therapy use (OR 1.05 per year, 95% CI 1.01-1.09, p=0.027). Between 2018 and 2023, pre-admission antithrombotic therapy use among recurrent ischemic stroke patients increased from 74.6% to 79.4% (OR 1.05 per year) but plateaued after 2019.

synapsesocial.com/papers/6ac74632947fe0d7c5643340 https://doi.org/10.5853/jos.2026.02761

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Secondary Prevention Gaps at Recurrent Ischemic Stroke Admission: A Nationwide Registry Study

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

Secondary Prevention Gaps at Recurrent Ischemic Stroke Admission: A Nationwide Registry Study

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

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