Knowledge of stroke risk factors among primary care patients with previous stroke or TIA: a questionnaire study

Abstract

Background: Survivers of stroke or transient ischaemic attacks (TIA) are at risk of new vascular events. Our objective was to study primary health care patients with stroke/TIA regarding their knowledge about risk factors for having a new event of stroke/TIA, possible associations between patient characteristics and patients' knowledge about risk factors, and patients' knowledge about their preventive treatment for stroke/TIA.

Methods: A questionnaire was distributed to 240 patients with stroke/TIA diagnoses, and 182 patients (76%) responded. We asked 13 questions about diseases/conditions and lifestyle factors known to be risk factors and four questions regarding other diseases/conditions ("distractors"). The patients were also asked whether they considered each disease/condition to be one of their own. Additional questions concerned the patients' social and functional status and their drug use. The t-test was used for continuous variables, chi-square test for categorical variables, and a regression model with variables influencing patient knowledge was created.

Results: Hypertension, hyperlipidemia and smoking were identified as risk factors by nearly 90% of patients, and atrial fibrillation and diabetes by less than 50%. Few patients considered the distractors as stroke/TIA risk factors (3-6%). Patients with a family history of cardiovascular disease, and patients diagnosed with carotid stenosis, atrial fibrillation or diabetes, knew these were stroke/TIA risk factors to a greater extent than patients without these conditions. Atrial fibrillation or a family history of cardiovascular disease was associated with better knowledge about risk factors, and higher age, cerebral haemorrhage and living alone with poorer knowledge. Only 56% of those taking anticoagulant drugs considered this as intended for prevention, while 48% of those taking platelet aggregation inhibitors thought this was for prevention.

Conclusions: Knowledge about hypertension, hyperlipidemia and smoking as risk factors was good, and patients who suffered from atrial fibrillation or carotid stenosis seemed to be well informed about these conditions as risk factors. However, the knowledge level was low regarding diabetes as a risk factor and regarding the use of anticoagulants and platelet aggregation inhibitors for stroke/TIA prevention. Better teaching strategies for stroke/TIA patients should be developed, with special attention focused on diabetic patients.

Figure 1

Patients' inclusion in the study and the response rate. Patients' inclusion in the study and the response rate. Inappropriately diagnosed patients: ¹⁾ 30 patients suffered from a condition other than stroke/TIA, although they initially had got this diagnosis registered; six patients suffered from traumatic brain haemorrhage, eight patients from subarachnoid haemorrhage (and were registered as I64, stroke not specified), and two patients from transient global amnesia (which is not a subtype of stroke/TIA). ²⁾ Excluded in order to make it possible to collect data from the records during a longer period and also to exclude patients still in a rehabilitation phase.

Figure 2

Proportion of patients who could correctly identify different numbers of stroke/TIA risk factors. Proportion of patients who could correctly identify different numbers of stroke/TIA risk factors.