Category: Health Services Research; Stroke
To describe the level of control of risk factors towards achieving secondary prevention after index-stroke over 1 year and determine associated determinants.
Retrospective cohort study with data from 10 primary care clinics extracted from the electronic health records between 2012 to 2016.
Participants (or Animals, Specimens, Cadavers) :
Consecutive sample of stroke patients (N=24,284) aged 21 years and above who had atleast 2 clinic visits over the observation period.
Interventions : Not applicable.
Main Outcome Measure(s) :
Proportion of stroke patients with controlled hypertension, glycaemic control, lipid control and overall control of combined risk factors.
More than half of the participants were 65 years and above (58.9%), with 57.7% male and majority were Chinese (80.1%), followed by Malay (10.8%), Indian (6.5%) and others (2.6%). About 41.4% had a body mass index (BMI) between 23.0 to 27.4. Proportion of patients with controlled hypertension, diabetes and hyperlipidaemia were 71.4%, 52.9% and 66.6%. Overall control was better in non-diabetic (49.2%) as compared to diabetic (28.1%) post-stroke patients. Among non-diabetics, gender (OR: 1.23; 95% CI: 1.10, 1.39), ethnicity, BMI and AF (OR: 1.47; 95% CI: 1.21, 1.78) were significantly associated with overall control. Among diabetics, gender (OR: 1.28; 95% CI: 1.12, 1.46), ethnicity, BMI, AF (OR: 1.24; 95% CI: 1.02, 1.51), chronic kidney disease (OR: 0.63; 95% CI: 0.54, 0.72) and smoking status (OR: 0.68; 95% CI: 0.53, 0.87) were significant covariates.
Having diabetes influenced the level of overall control achieved and future research efforts should focus on patients with comorbidities and qualitatively explore patients' experience of secondary prevention. Irrespective of diabetic status, being female and of Malay/Indian ethnicity were associated with poor overall control and interventions targeting these sub-groups might be helpful.
Vivek Bansal– Family Physician, National Healthcare Group Polyclinics (NHGP), Singapore, Singapore
Shilpa Tyagi– PhD Candidate, Saw Swee Hock School of Public Health, National University of Singapore, Singapore
Eng Sing Lee– Family Physician senior consultant, National Healthcare Group Polyclinics (NHGP), Singapore, Singapore
Helen Smith– Director, Centre for Primary Healthcare Research & Innovation, Singapore