Under-prescribing of Prevention Drugs and Primary Prevention of Stroke and Transient Ischaemic Attack in UK General Practice: A Retrospective Analysis

• Published in: PLoS medicine Vol. 13; no. 11; p. e1002169
• Main Authors: Turner, Grace M, Calvert, Melanie, Feltham, Max G, Ryan, Ronan, Fitzmaurice, David, Cheng, K K, Marshall, Tom
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 15.11.2016; Public Library of Science (PLoS)
• Subjects: Anticoagulants; Anticoagulants - therapeutic use; Antihypertensive agents; Antihypertensive Agents - therapeutic use; Biology and Life Sciences; Blood pressure; Care and treatment; Dosage and administration; Drug Prescriptions - statistics & numerical data; General Practice - statistics & numerical data; Hypolipidemic Agents - therapeutic use; Ischemic Attack, Transient - drug therapy; Ischemic Attack, Transient - prevention & control; Medicine and Health Sciences; Pharmaceutical Preparations - supply & distribution; Prescription drugs; Prevention; Primary Prevention - statistics & numerical data; Retrospective Studies; Risk factors; Stroke; Stroke - drug therapy; Stroke - prevention & control; Studies; Transient ischemic attack; United Kingdom; United Kingdom
• ISSN: 1549-1676; 1549-1277; 1549-1676
• DOI: 10.1371/journal.pmed.1002169

Stroke is a leading cause of death and disability; worldwide it is estimated that 16.9 million people have a first stroke each year. Lipid-lowering, anticoagulant, and antihypertensive drugs can prevent strokes, but may be underused. We analysed anonymised electronic primary care records from a United Kingdom (UK) primary care database that covers approximately 6% of the UK population. Patients with first-ever stroke/transient ischaemic attack (TIA), ≥18 y, with diagnosis between 1 January 2009 and 31 December 2013, were included. Drugs were considered under-prescribed when lipid-lowering, anticoagulant, or antihypertensive drugs were clinically indicated but were not prescribed prior to the time of stroke or TIA. The proportions of strokes or TIAs with prevention drugs under-prescribed, when clinically indicated, were calculated. In all, 29,043 stroke/TIA patients met the inclusion criteria; 17,680 had ≥1 prevention drug clinically indicated: 16,028 had lipid-lowering drugs indicated, 3,194 anticoagulant drugs, and 7,008 antihypertensive drugs. At least one prevention drug was not prescribed when clinically indicated in 54% (9,579/17,680) of stroke/TIA patients: 49% (7,836/16,028) were not prescribed lipid-lowering drugs, 52% (1,647/3,194) were not prescribed anticoagulant drugs, and 25% (1,740/7,008) were not prescribed antihypertensive drugs. The limitations of our study are that our definition of under-prescribing of drugs for stroke/TIA prevention did not address patients' adherence to medication or medication targets, such as blood pressure levels. In our study, over half of people eligible for lipid-lowering, anticoagulant, or antihypertensive drugs were not prescribed them prior to first stroke/TIA. We estimate that approximately 12,000 first strokes could potentially be prevented annually in the UK through optimal prescribing of these drugs. Improving prescription of lipid-lowering, anticoagulant, and antihypertensive drugs is important to reduce the incidence and burden of stroke and TIA.