Integrated stroke care and risk of recurrent stroke: Compliance with the ABCstroke pathway in Denmark

Background Survival after ischemic stroke has improved, leaving more patients at risk of recurrent events and in need of effective secondary prevention. However, implementation of guideline-recommended care remains inconsistent, especially during the transition from hospital to primary care. The ABCstroke pathway offers an integrated approach encompassing (A) appropriate antithrombotic therapy, (B) better functional and psychological health, and (C) comprehensive cardiovascular risk factor management. As stroke prognosis varies with age, it is important to understand whether the impact of integrated care differs across age groups. Purpose To examine the association between baseline ABCstroke pathway compliance and the risk of recurrent stroke in Denmark. Methods We conducted a nationwide registry-based cohort study including patients aged 18–80 years with incident ischemic stroke recorded in the Danish Stroke Registry (2015–2023). Baseline ABCstroke pathway compliance was assessed 30 days after hospital discharge using linked national data on (A) antithrombotic therapy, (B) hospital-based physical assessments and referral to municipal rehabilitation services, and (C) medical management of hypertension, hyperlipidaemia, heart failure, ischemic heart disease, and diabetes mellitus. Each fulfilled component scored 1 point. Compliance was categorized as high (2–3 points) or low (0–1 point). Follow-up for recurrent stroke began at day 30 after discharge, and patients were followed for up to two years. Associations were reported as crude (unadjusted) estimates, stratified by age (<70 vs. ≥70 years). Results Among 42,996 patients (39% female, median age 68 years), 83% were classified as high and 17% as low ABCstroke pathway compliant, and this distribution was similar across the two age groups. In age-stratified analyses (Figure 1), modest separation of the time-to-event curves was observed among patients aged <70 years, indicating a tendency toward lower recurrent stroke risk among those with high compliance. In contrast, the curves for patients ≥70 years showed minimal divergence. Conclusion Baseline ABCstroke pathway compliance appeared more influential among patients younger than 70 years, where early integrated care was associated with lower recurrent stroke risk. In older patients, no clear differences were observed, suggesting that recurrent stroke risk at higher ages is likely shaped by multiple competing prognostic factors that require attention in future analyses.