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PLoS Med. 2016 Nov 15;13(11):e1002169. doi: 10.1371/journal.pmed.1002169. eCollection 2016 Nov.

Under-prescribing of Prevention Drugs and Primary Prevention of Stroke and Transient Ischaemic Attack in UK General Practice: A Retrospective Analysis.

Author information

1
Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom.

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.

PMID:
27846215
PMCID:
PMC5112771
DOI:
10.1371/journal.pmed.1002169
[Indexed for MEDLINE]
Free PMC Article

Conflict of interest statement

GMT reports grants from National Institute for Health Research (NIHR) School for Primary Care Research (SPCR), during the conduct of the study; TM reports funding from the NIHR through the Collaborations for Leadership in Applied Health Research and Care for West Midlands (CLAHRC-WM); MC reports funding from European Society of Cardiology & AFNET, and personal fees from Astellas Pharma, outside the submitted work. KC reports grants from Pfizer China, outside the submitted work. MGF and RR have nothing to disclose.

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