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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 ISSN 1549-1277.

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Official URL: http://dx.doi.org/10.1371/journal.pmed.1002169

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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
Subjects: R Medicine > RC Internal medicine
R Medicine > RM Therapeutics. Pharmacology
Divisions: Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School > Clinical Trials Unit
Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School > Health Sciences
Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School
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:
DateEvent
15 November 2016Published
5 October 2016Accepted
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 (Creative Commons)
Date of first compliant deposit: 24 November 2017
Date of first compliant Open Access: 24 November 2017
RIOXX Funder/Project Grant:
Project/Grant IDRIOXX Funder NameFunder ID
Collaborations for Leadership in Applied Health ResearchNational Institute for Health Researchhttp://dx.doi.org/10.13039/501100000272
UNSPECIFIEDEuropean Society Of Cardiologyhttp://dx.doi.org/10.13039/501100000860

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