Article

PROTECT: A coordinated stroke treatment program to prevent recurrent thromboembolic events

Stroke Center and Department of Neurology, UCLA Medical Center, Los Angeles, CA, USA.
Neurology (Impact Factor: 8.3). 11/2004; 63(7):1217-22. DOI: 10.1212/01.WNL.0000140493.83607.F1
Source: PubMed

ABSTRACT To assess the impact of the Preventing Recurrence of Thromboembolic Events through Coordinated Treatment (PROTECT) Program on achievement of its eight secondary prevention goals at the time of discharge.
Achievement rates for the eight program goals at time of discharge were compared in all patients discharged from a university hospital-based stroke service with a diagnosis of ischemic stroke or TIA during a 1-year period after implementation of the PROTECT Program vs rates obtained from a comparable group of patients admitted to the same service during the preceding year.
Demographic and medical features were comparable in the baseline and intervention cohorts for all patients with cerebral ischemia presumed due to large-vessel atherosclerosis or small-vessel disease (baseline year n = 117, intervention n = 130). Implementation rates in patients without specific contraindications increased for all four medication goals: 97 to 100% for antithrombotic agents, 68 to 97% for statins, 42 to 90% for angiotensin-converting enzyme inhibitors/angiotensin receptor blockers, and 14 to 70% for diuretics. Although data were not collected on baseline lifestyle instruction rates, instruction in the program's four lifestyle interventions was achieved by discharge in 100% of the intervention cohort.
Implementation of this single-center, systems-based, in-hospital program to initiate secondary stroke prevention therapies was associated with a substantial increase in treatment utilization at the time of hospital discharge.

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    • "Interventions should be multimodal, i.e. they should include the prescription of secondary prevention medication (e.g. antihypertensives, statins) in conjunction with the active provision of lifestyle information, and education regarding behaviour modification strategies [10]. "
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    • "Socio-demographic, self-reported medical history, and vascular risk biomarker data were assessed and included: age, sex, race, ethnicity, histories of hypertension, diabetes, smoking, hypercholesterolemia , previous stroke or TIA, and coronary (CAD) and peripheral arterial disease (PAD) [3] [4]. CAD was defined as history of coronary heart disease, physician diagnosed myocardial infarct or angina pectoris, or EKG evidence of an old myocardial infarct prior to index stroke or TIA. "
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    ABSTRACT: Cerebrovascular disease is the third leading cause of mortality and the leading cause of long-term neurological disability in the United States. Most strokes are of ischemic origin and, other than cardioembolic or small vessel strokes, are caused by the development of platelet-fibrin thrombi on an atherosclerotic plaque. This underlying disease mechanism shares important features with coronary artery disease and peripheral artery disease, highlighting the systemic nature of atherothrombosis and the elevated cross risk in stroke patients for ischemic events in other vascular beds. It has been estimated that up to 80% of ischemic strokes could be prevented with application of currently available treatments for blood pressure, cholesterol, and antithrombotic therapies. Stroke is not, like cancer, waiting for a scientific breakthrough; stroke preventive treatments are well understood and widely available. It is only the application of these treatments to patients, many of whom do not visit physicians, that is lacking. Clearly, better education of the public and active participation of primary care physicians is essential to get the message out to all those at risk.
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