A Failing Grade in Stroke Prevention
"We might have expected a gap of 10% or so between what should be done and what in fact is being done. The magnitude of the difference we found was really alarming to us," says Lichtman.
The patient chart review showed a consistent disregard for preventive treatment across most subgroups. No evidence of gender, age, or race bias emerged from the data, according to Lichtman. In fact, those in the most elderly subgroup (75 and older) were more likely to receive anti-clotting therapy than were patients younger than 65.
"If anything, there was a bias against preventive therapy in younger people," says Lichtman. "The patient, the treating physician, or both might have assumed there was no reason to be concerned about stroke because of the person's younger age."
More than 80% of the study population had some evidence of stroke risk, said Lawrence Brass, MD, a professor of neurology at Yale. All of them should have been on some form of preventive therapy, he said.
"The real issue is why -- why were these patients not receiving preventive therapy?" says Brass. "We know from other work by our group that the answer is probably multifactorial."
"The take-home message from this study is that everybody needs to be involved in stroke prevention," Brass says. "The take-home message is that everybody can be involved in enhancement of stroke prevention. Some of the information and education needs to be directed toward patients and some toward physicians."