Accepted Manuscript Secondary Prevention after Ischemic Stroke or Transient Ischemic Attack Sripal Bangalore, MD, MHA Lee Schwamm, MD Eric E. Smith, MD, MPH Inder M. Singh, MD, MS Li Liang, PhD Gregg C. Fonarow, MD Deepak L. . Bhatt, MD, MPH PII:
To appear in:
The American Journal of Medicine
Received Date: 6 March 2014 Revised Date:
10 March 2014
Accepted Date: 10 March 2014
Please cite this article as: Bangalore S, Schwamm L, Smith EE, Singh IM, Liang L, Fonarow GC, . Bhatt DL, , Secondary Prevention after Ischemic Stroke or Transient Ischemic Attack, The American Journal of Medicine (2014), doi: 10.1016/j.amjmed.2014.03.011. This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
Secondary Prevention after Ischemic Stroke or Transient Ischemic Attack
Sripal Bangalore, MD, MHA, Lee Schwamm MD, Eric E. Smith, MD, MPH, Inder M. Singh, MD, MS, Li Liang, PhD, Gregg C Fonarow, MD, Deepak L. Bhatt, MD, MPH; for the Get With the Guidelines-Stroke Steering Committee and Investigators New York University Medical Center, New York, NY [SB] Massachusetts General Hospital, Boston, MA [LS] Hotchkiss Brain Institute, University of Calgary [EES] Mercy Heart and Vascular Institute, Sacramento, CA [IMS] Duke Clinical Research Institute, Durham, NC [LL] Ahmanson-UCLA Cardiomyopathy Center, Los Angeles, CA [GCF] VA Boston Healthcare System, Brigham and Women's Hospital, and Harvard Medical School, Boston, MA [DLB]
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Word Count: 2956
Running Title: Secondary prevention after stroke/transient ischemic attack
Funding Source: The GWTG-Stroke program is provided by the AHA/American Stroke Association. The GWTG-Stroke program is currently supported in part by a charitable contribution from Janssen Pharmaceutical Companies of Johnson & Johnson. GWTG Stroke has been funded in the past through support from Boehringer-Ingelheim, Merck, Bristol-Myers Squib/Sanofi Pharmaceutical Partnership, and the AHA Pharmaceutical Roundtable. Role of the Sponsor: The industry sponsors of GWTG Stroke had no role in the design and conduct of the study; in the collection, analysis, and interpretation of the data; or in the preparation, review, or approval of the manuscript.
Disclosures: Dr. Sripal Bangalore reports no disclosures Dr. Lee Schwamm reports the following- I serve as the unpaid chair of the AHA GWTG Stroke Clinical Working Group. I serve as a Stroke Systems of Care Expert Consultant and measure development expert to the Joint Commission; Coverdell Registry/MA Dept of Public Health. I am on the steering committee for the Medtronic Victory AF trial; and the DSMB for the NovoNordisk DEVOTE trial. I receive research funding from NINDS and PCORI Dr. Eric Smith reports no disclosures Dr. Inder Singh reports no disclosures Dr. Li Liang reports no disclosures Dr. Gregg C. Fonarow reports the following: Employment – UCLA Employee, which holds a patent on stroke retriever devices NIH – Grants and grants pending. Dr. Deepak L. Bhatt discloses the following relationships - Advisory Board: Elsevier Practice Update Cardiology, Medscape Cardiology, Regado Biosciences; Board of Directors: Boston VA Research Institute, Society of Cardiovascular Patient Care; Chair: American Heart Association Get With The Guidelines Steering Committee; Data Monitoring Committees: Duke Clinical Research Institute; Harvard Clinical Research Institute; Mayo Clinic; Population Health Research Institute; Honoraria: American 1
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Reprint Request and Correspondence: Sripal Bangalore, MD, MHA, FACC, FAHA, FSCAI Director, Cardiovascular Outcomes Group, Director of Research, Cardiac Catheterization Laboratory, Cardiovascular Clinical Research Center, Associate Professor of Medicine, The Leon H. Charney Division of Cardiology, New York University School of Medicine, New York, NY 10016 Email: [email protected]
Phone: 212-263-3540 Fax: 212-263-3988
All authors had access to the data and a role in writing the manuscript.
College of Cardiology (Editor, Clinical Trials, Cardiosource), Belvoir Publications (Editor in Chief, Harvard Heart Letter), Duke Clinical Research Institute (clinical trial steering committees), Harvard Clinical Research Institute (clinical trial steering committee), HMP Communications (Editor in Chief, Journal of Invasive Cardiology); Population Health Research Institute (clinical trial steering committee), Slack Publications (Chief Medical Editor, Cardiology Today’s Intervention), WebMD (CME steering committees); Other: Clinical Cardiology (Associate Editor); Journal of the American College of Cardiology (Section Editor, Pharmacology); Research Grants: Amarin, AstraZeneca, Bristol-Myers Squibb, Eisai, Ethicon, Medtronic, Roche, Sanofi Aventis, The Medicines Company; Unfunded Research: FlowCo, PLx Pharma, Takeda.
BACKGROUND: Patients with stroke or transient ischemic attack are at increased risk of recurrent stroke. Transient ischemic attack is a harbinger for stroke merely hours to days after the initial transient ischemic attack. There is thus a narrow window of opportunity to initiate
evidence-based therapies for secondary prevention of stroke. Our objective was to assess hospital adherence at discharge to secondary prevention measures after transient ischemic attack or
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METHODS: Observational study of patients in the Get With The Guidelines-Stroke registry from 2007 to 2011. Patients were divided into 2 cohorts based on presentation- transient
ischemic attack vs. ischemic stroke. Adherence to evidence-based secondary prevention and other quality measures were assessed.
RESULTS: Among the 858,835 patients with transient ischemic attack or ischemic stroke, 259,319 (30%) patients presented with a transient ischemic attack and 599,516 (70%) patients
presented with an ischemic stroke. After adjusting for patient and hospital characteristics, adherence to secondary prevention measures was consistently lower for the transient ischemic attack cohort (vs. ischemic stroke cohort) who had lower odds of being discharged on antithrombotics (Odds Ratio (OR)=0.63; 95% confidence interval (CI) 0.59-0.66; P