Limited Efficacy of a Long-term Secondary Prevention Program in Ischemic Stroke and Transient Ischemic Attack Patients.

BACKGROUND Few studies have focused on the quality of care with regard to long-term secondary prevention after transient ischemic attack (TIA) or ischemic stroke. The aim of this study was 2-fold: (1) to determine if ischemic stroke and TIA patients are motivated for a long-term secondary prevention program after hospital discharge and (2) to study the effect of this program on the attainment of guideline-recommended secondary prevention targets. METHODS A single-center, cohort study of ischemic stroke and TIA patients. The number of visits to the long-term secondary prevention program and the number of patients whom achieved the composite end point of optimal medical therapy at their last visit to our outpatient clinic were assessed. RESULTS Of the 237 included ischemic stroke and TIA patients, only 164 (69%) visited the long-term secondary prevention program at least once. Of these patients, 37% reached the primary end point of optimal medical treatment at their last visit to our outpatient clinic. We found a significant increase in secondary prevention target attainment for the primary outcome of optimal medical treatment and its individual components. CONCLUSIONS Despite our systematic approach to care for patients after ischemic stroke or TIA, we observed that 31% of our patients did not visit our outpatient clinic for the long-term secondary prevention program at all. In addition, the long-term secondary prevention program alone, consisting of regular follow-up visits and a medication treatment algorithm, was not sufficient to reach guideline-recommended treatment targets in most of our ischemic stroke and TIA patients.