Assessment of the quality of secondary ischemic stroke prevention in selected urban areas of Poland and Ukraine: the ASCEP study results

Abstract

The aim of this study was to assess the quality of secondary ischemic stroke (IS) prevention among subjects after IS from selected urban areas of Poland (Gdynia, G) and Ukraine (Lutsk, L).

Methods: The study was conducted on representative samples of post-IS patients from G and L who suffered from IS in the years 2000-2005. A questionnaire, anthropometric and blood pressure (BP) measurements and laboratory tests were performed.

Results: The data of 440 patients were collected. Only 47% in G and 58% in L (p < 0.05) had visited a neurologist within 6 months before the interview. Results of the prevalence and control of consecutive IS risk factors were estimated: (1) arterial hypertension (prevalence: 88% G, 92% L, p = 0.1; BP <140/90 mm Hg: 23% G, 16% L, p = 0.02); (2) hypercholesterolemia (prevalence: 90% G, 76% L, p < 0.05; total cholesterol <175 mg/dl: 11% G, 6% L, p = 0.05); (3) self-reported diabetes or glycemia >125 mg/dl: 22% G, 17% L, p = 0.08; (4) smoking: 26% men versus 16% women in G, 33% men versus 2% women in L, p < 0.05, and (5) self-reported atrial fibrillation: 28% G, 7% L, p < 0.05. Antiplatelet drugs or oral anticoagulants were taken by 51% G versus 45.5% L (not significant).

Conclusions: The quality of secondary IS prevention is insufficient, and there is a need for complex educational interventions in patients, their families and medical staff. Our data also call for organizational changes in the health service both in Poland and Ukraine.