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Under-prescribing of prevention drugs and primary prevention of stroke and transient ischaemic attack in UK general practice : a retrospective analysis
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Turner, Grace M., Calvert, Melanie, Feltham, Max G., Ryan, Ronan, Fitzmaurice, David A., Cheng, K. K. and Marshall, Tom (2016) Under-prescribing of prevention drugs and primary prevention of stroke and transient ischaemic attack in UK general practice : a retrospective analysis. PLoS Medicine, 13 (11). e1002169. doi:10.1371/journal.pmed.1002169
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WRAP-under-prescribing-prevention-drugs-primary-prevention-Fitzmaurice-2017.pdf - Published Version - Requires a PDF viewer. Available under License Creative Commons Attribution 4.0. Download (1544Kb) | Preview |
Official URL: http://dx.doi.org/10.1371/journal.pmed.1002169
Abstract
Background:
Stroke is a leading cause of death and disability; worldwide it is estimated that 16.9 million people have a first stroke each year. Lipid-lowering, anticoagulant, and antihypertensive drugs can prevent strokes, but may be underused.
Methods and Findings:
We analysed anonymised electronic primary care records from a United Kingdom (UK) primary care database that covers approximately 6% of the UK population. Patients with first-ever stroke/transient ischaemic attack (TIA), ≥18 y, with diagnosis between 1 January 2009 and 31 December 2013, were included. Drugs were considered under-prescribed when lipid-lowering, anticoagulant, or antihypertensive drugs were clinically indicated but were not prescribed prior to the time of stroke or TIA. The proportions of strokes or TIAs with prevention drugs under-prescribed, when clinically indicated, were calculated.
In all, 29,043 stroke/TIA patients met the inclusion criteria; 17,680 had ≥1 prevention drug clinically indicated: 16,028 had lipid-lowering drugs indicated, 3,194 anticoagulant drugs, and 7,008 antihypertensive drugs. At least one prevention drug was not prescribed when clinically indicated in 54% (9,579/17,680) of stroke/TIA patients: 49% (7,836/16,028) were not prescribed lipid-lowering drugs, 52% (1,647/3,194) were not prescribed anticoagulant drugs, and 25% (1,740/7,008) were not prescribed antihypertensive drugs.
The limitations of our study are that our definition of under-prescribing of drugs for stroke/TIA prevention did not address patients’ adherence to medication or medication targets, such as blood pressure levels.
Conclusions:
In our study, over half of people eligible for lipid-lowering, anticoagulant, or antihypertensive drugs were not prescribed them prior to first stroke/TIA. We estimate that approximately 12,000 first strokes could potentially be prevented annually in the UK through optimal prescribing of these drugs. Improving prescription of lipid-lowering, anticoagulant, and antihypertensive drugs is important to reduce the incidence and burden of stroke and TIA.
| Item Type: | Journal Article | |||||||||
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| Subjects: | R Medicine > RC Internal medicine R Medicine > RM Therapeutics. Pharmacology |
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| Divisions: | Faculty of Medicine > Warwick Medical School > Health Sciences > Clinical Trials Unit Faculty of Medicine > Warwick Medical School > Health Sciences Faculty of Medicine > Warwick Medical School |
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| Library of Congress Subject Headings (LCSH): | Cerebrovascular disease -- Prevention, Anticoagulants (Medicine) -- Prescribing, Hypotensive agents -- Prescribing, Antilipemic agents -- Prescribing | |||||||||
| Journal or Publication Title: | PLoS Medicine | |||||||||
| Publisher: | Public Library of Science | |||||||||
| ISSN: | 1549-1277 | |||||||||
| Official Date: | 15 November 2016 | |||||||||
| Dates: |
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| Volume: | 13 | |||||||||
| Number: | 11 | |||||||||
| Article Number: | e1002169 | |||||||||
| DOI: | 10.1371/journal.pmed.1002169 | |||||||||
| Status: | Peer Reviewed | |||||||||
| Publication Status: | Published | |||||||||
| Access rights to Published version: | Open Access | |||||||||
| RIOXX Funder/Project Grant: |
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