THE STUDY "REGISTER OF PATIENTS AFTER ACUTE STROKE (REGION)". PART 2. OUTPATIENT PROSPECTIVE REGISTER OF PATIENTS AFTER ACUTE STROKE (ACCORDING TO THE RESULTS OF THE PILOT PHASE OF THE STUDY)

Abstract

Aim. To study particularities of course and outcomes of acute cerebrovascular accident (ACVA), quality of examination and medical treatment within a framework of an outpatient register.Material and methods. Two outpatient registries were organized on the base of one of Ryazan outpatient clinics within a framework of the pilot phase of the REGION study: the register of patients who had experienced ACVA of any remoteness (ACVA-AR register, n=200) and the register of patients who had visited the outpatient clinic for the first time after cerebral stroke (ACVA-FV register, n=115). Particularities of ACVA development, concomitant cardiovascular diseases (CVD) and noncardiac diseases were analyzed. We estimated accordance of methods of examination and prescribed medical treatment with clinical guidelines. Long-term outcomes were also evaluated in the course of prospective follow-up.Results. Patients of both registers had concomitant CVD (on an average 3 diagnosis) and noncardiac comorbidity (on an average 1 diagnosis). Majority of patients at the outpatient phase received inadequate treatment for cardiovascular risk decrease, especially before reference ACVA. The ACVA-FV register patients as compared to the ACVA-AR ones (who had experienced ACVA on an average 4.8 years earlier) were more often (p<0.05) examined by instrumental and laboratory methods of diagnostics during the post-stroke follow-up in outpatient settings. ACVA-FV register patients as compared to the ACVA-AR ones were also more often (p˂0.05) prescribed prognosis-modifying therapy (statins – 46.9% vs 11%, acetylsalicylic acid – 54.8% vs 28%, ACE inhibitors – 46.1% vs 29%, and anticoagulants in atrial fibrillation – 17.6% vs 2.3%, respectively). Mortality rates in the ACVA-AR and ACVA-FV registers for 2 years were 15.5% and 32.2%, respectively (p=0.005), incidence rates of myocardial infarction – 2.5% and 0%, respectively (p=0.09), recurrent ACVA – 14.5% and 11.3%, respectively, (p=0.42).Conclusion. Examination and medical treatment of the patients in the outpatient clinic were suboptimal especially before ACVA development. However examination and treatment quality had improved significantly (although insufficiently) during 5-year time span between ACVA development in the ACVA-AR and ACVA-FV registers. High mortality rate (22.7%) in the first 3 months of outpatient follow-up after ACVA is an unsolved challenge.

Keywords

• acute cerebrovascular accident
• cerebral stroke
• transient ischemic attack
• outpatient register
• estimation of accordance of therapy with clinical guidelines
• prospective follow-up
• long-term outcomes