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From the Stroke Center and Department of Neurology (Drs. Ovbiagele, Saver, Fredieu, Suzuki, and Kidwell, A. Dandekar and T. Razinia) and Department of Nursing (N. McNair), UCLA Medical Center, and Department of Neurology (Drs. Ovbiagele, Saver, Fredieu, Suzuki, and Kidwell), Olive View–UCLA Medical Center, Los Angeles, CA.
Address correspondence and reprint requests to Dr. B. Ovbiagele, Stroke Center and Department of Neurology, University of California at Los Angeles, 710 Westwood Plaza, Los Angeles, CA 90095; e-mail: Ovibes{at}mednet.ucla.edu
Objective: To assess the impact of the Preventing Recurrence of Thromboembolic Events through Coordinated Treatment (PROTECT) Program on achievement of its eight secondary prevention goals at the time of discharge.
Methods: Achievement rates for the eight program goals at time of discharge were compared in all patients discharged from a university hospital-based stroke service with a diagnosis of ischemic stroke or TIA during a 1-year period after implementation of the PROTECT Program vs rates obtained from a comparable group of patients admitted to the same service during the preceding year.
Results: Demographic and medical features were comparable in the baseline and intervention cohorts for all patients with cerebral ischemia presumed due to large-vessel atherosclerosis or small-vessel disease (baseline year n = 117, intervention n = 130). Implementation rates in patients without specific contraindications increased for all four medication goals: 97 to 100% for antithrombotic agents, 68 to 97% for statins, 42 to 90% for angiotensin-converting enzyme inhibitors/angiotensin receptor blockers, and 14 to 70% for diuretics. Although data were not collected on baseline lifestyle instruction rates, instruction in the program’s four lifestyle interventions was achieved by discharge in 100% of the intervention cohort.
Conclusion: Implementation of this single-center, systems-based, in-hospital program to initiate secondary stroke prevention therapies was associated with a substantial increase in treatment utilization at the time of hospital discharge.
Received March 2, 2004. Accepted in final form May 19, 2004.
Additional material related to this article can be found on the Neurology Web site. Go to www.neurology.org and scroll down the Table of Contents for the October 12 issue to find the title link for this article.
Dr. Ovbiagele has acted as a paid scientific consultant for Bristol–Myers–Squibb and Sanofi Pharmaceuticals and has received speaker honoraria from Boehringer–Ingelheim. Dr. Saver has acted as a paid scientific consultant for Bristol–Myers–Squibb, Sanofi Pharmaceuticals, Boehringer–Ingelheim, and Wyeth and has received speaker honoraria from Bristol–Myers–Squibb and Sanofi Pharmaceuticals. Dr. Kidwell has acted as a paid scientific consultant for Bristol–Myers–Squibb and Sanofi Pharmaceuticals.
Related Article
Neurology 2004 63: 1146-1147.
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