Abstract TP420: At-risk Stroke Patients in Need of In-hospital Lifestyle Interventions

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Introduction: Lifestyle factors such as weight, diet and smoking are associated with stroke incidence and recurrence. Targeted interventions on these risk factors can be successful in reducing stroke and TIA (Transient Ischemic Attack) rates. The objective of this study was to assess the number of patients presenting to a hospital with an ischemic stroke (ISC) or TIA who received lifestyle interventions in a large, multi-hospital health system.

Methods: Data from 25 hospitals in a multi-state healthcare system stroke registry from 2002 to May 2015 were used. Patients with a diagnosis of ISC or TIA were included. Patients on comfort care, transferred to an outside facility from the emergency department, discharged to hospice or expired were excluded. Lifestyle intervention outcome measures included the percentage of patients who received information on weight and activity management, anti-hypertensive diet, cholesterol reducing diet and anti-smoking treatment. Outcomes were evaluated by risk groups including patients with Body Mass Index (BMI) ≥25, those prescribed anti-hypertensive or cholesterol lowering medications in-hospital and smokers.

Results: A total of 39,200 patients met inclusion criteria. Analytic sample sizes ranged from 6, 576 to 39,200. Over sixty-four percent had BMI≥25 (n=16,527), 75.5% (n=23,364) were prescribed anti-hypertensive medication, 78.4% (n=29,609) were prescribed cholesterol lowering medication and 16.8% (n=6,576) were smokers. Among those with BMI ≥ 25, only 42.6% (n=6,560) received weight management intervention. Among those that were prescribed anti-hypertensive medication, 50.6% (n=8,463) received information on antihypertensive diet. Among those that were prescribed cholesterol lowering medication, 57.1% (n=10,648) received cholesterol lowering diet information. For those that smoked, 90.1% (n=5,923) received anti-smoking treatment.

Conclusions: This large patient cohort demonstrates there are improvement opportunities for in-hospital stroke prevention efforts. While hospitals do a good job appropriately providing smoking treatment to stroke patients, lifestyle interventions such as weight management and diet should also be addressed for those at-risk.

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