van Schaik Sander M, de Vries Blanche S, Weinstein Henry C, Visser Marieke C, Van den Berg-Vos Renske M
Department of Neurology, Sint Lucas Andreas Ziekenhuis, Amsterdam, The Netherlands.
Department of Neurology, Sint Lucas Andreas Ziekenhuis, Amsterdam, The Netherlands.
J Stroke Cerebrovasc Dis. 2015 Mar;24(3):566-72. doi: 10.1016/j.jstrokecerebrovasdis.2014.09.031. Epub 2014 Dec 24.
Stroke guidelines emphasize the importance of adequate vascular risk factor assessment and management in transient ischemic attack (TIA) and ischemic stroke patients, but it is not clear how these guidelines are applied in routine clinical practice. The limited data that are available indicate that TIA and ischemic stroke patients often do not receive the recommended interventions. The aim of this study was to investigate practice variations in long-term secondary stroke prevention in The Netherlands.
Between June and December 2013, an invitation for a web-based survey was sent to 90 Dutch neurologists with a special interest in stroke neurology. This web-based survey contained questions regarding the organization of outpatient care for TIA and ischemic stroke patients after initial hospital assessment, pharmacologic treatment, and nonpharmacologic strategies for long-term secondary prevention.
In total, 84 (93%) neurologists completed the survey. Although nearly all respondents reported that they follow-up TIA and ischemic stroke patients after initial hospital assessment, the number of follow-up visits and the follow-up duration were variable. A similar variation was found in treatment targets levels for both blood pressure and low-density lipoprotein cholesterol. Regarding nonpharmacologic strategies for long-term secondary stroke prevention, most respondents inform their TIA and ischemic stroke patients about the importance of smoking cessation. There is considerably less attention for the other lifestyle risk factors.
We found considerable practice variation in long-term secondary stroke prevention. These variations may have an impact on the risk for stroke recurrence and cardiovascular disease in general.
卒中指南强调在短暂性脑缺血发作（TIA）和缺血性卒中患者中进行充分的血管危险因素评估和管理的重要性，但尚不清楚这些指南在常规临床实践中是如何应用的。现有的有限数据表明，TIA和缺血性卒中患者常常未接受推荐的干预措施。本研究的目的是调查荷兰长期二级卒中预防中的实践差异。
2013年6月至12月期间，向90名对卒中神经病学有特殊兴趣的荷兰神经科医生发出了基于网络的调查邀请。该基于网络的调查包含有关TIA和缺血性卒中患者在初次住院评估后的门诊护理组织、药物治疗以及长期二级预防的非药物策略等问题。
共有84名（93%）神经科医生完成了调查。尽管几乎所有受访者都报告称他们在初次住院评估后对TIA和缺血性卒中患者进行随访，但随访次数和随访时长各不相同。在血压和低密度脂蛋白胆固醇的治疗目标水平方面也发现了类似的差异。关于长期二级卒中预防的非药物策略，大多数受访者告知他们的TIA和缺血性卒中患者戒烟的重要性。对其他生活方式危险因素的关注则少得多。
我们发现长期二级卒中预防中存在相当大的实践差异。这些差异可能总体上对卒中复发风险和心血管疾病产生影响。
