Preventing Strokes: The National Perspective

1
Preventing StrokesThe National Perspective

• Professor Mike Pringle
• Gloucester PCCAG Stroke Study Day
• 30th November 2005

2
Overview

• National UK audit of stroke in general practice
• Using routine data (QRESEARCH)
• Prevalence and Incidence
• Recorded levels of BP, Cholesterol and therapy

3
Key Features of QRESEARCH

• Non-profit making
• Partnership between University of Nottingham and
  EMIS
• Nationally representative sample of over 500
  volunteering EMIS general practices
• 3.5 million active patients over 7 million
  including lefts and dieds
• Data quality assured
• Feedback to practices

4
What is QRESEARCH for?

• RESEARCH
• Patient level subsets for bone fide researchers
  who have ethical committee approval and are free
  to publish
• HEALTH SERVICES
• Tabular analyses for health service use e.g.
  morbidity, benchmarking, policy development

5
Who did the work?

• Professor Julia Hippisley-Cox
• Ronan Ryan, Researcher
• Professor Mike Pringle
• Division of Primary Care, University of
  Nottingham

6
The dataset used for the National Stroke Audit in
General Practice

• Data uploaded 10th May 2004
• 200 practices contributing
• 1,476,000 current registered patients
• Malesfemales
• Every SHA in England, Wales and Scotland
  represented

7
Results Prevalence

• Crude prevalence of 7.38 per 1000 current patients

8
Results BP Control

• Crude prevalence of 7.38 per 1000 current
  patients
• Three quarters of prevalent cases have at least
  one major co-morbidity
• 47 have last BP of or under 140/85
• 67 have last BP of or under 150/90
• 88 have BP reading in last year of those 76
  have last BP under 150/90

9
Results Cholesterol

• Crude prevalence of 7.38 per 1000 current
  patients
• 59 have a cholesterol level recorded in last 15
  months
• 65 had a level total cholesterol of 5 mmol/l or
  less
• Half of all patients with stroke on a lipid
  lowering agent

10
Results Anti-platelets

• Crude prevalence of 7.38 per 1000 current
  patients
• 58 have had aspirin or anticoagulant in past 15
  months

11
Results Incidence

• Incidence period is the two years April 2002 to
  March 2004
• First ever recorded stroke
• Looked at care in year before their incident
  stroke and in year after

12
Results Incidence

• Incidence of 1.36 per 1000 years of observation

13
Results Incidence

• Incidence of 1.36 per 1000 years of observation
• 24.4 died in the 2 year period highest
  immediately post-stroke

14
Results BP Control

• Incidence of 1.36 per 1000 years of observation
• 37 had a recording of a BP of over 150/90 in
  year before stroke
• Post-stroke 18.7 had a BP reading over 150/90
  25 of those with a BP reading recorded

15
Results Cholesterol

• Incidence of 1.36 per 1000 years of observation
• Only 33 had a recording of a Cholesterol level
  in year before stroke
• 22 were prescribed lipid lowering drug in year
  before stroke
• 43 were prescribed lipid lowering drug in year
  after stroke

16
Results Anti-platelets

• Incidence of 1.36 per 1000 years of observation
• 48.8 prescribed anti-platelet drug before stroke
• 63.9 prescribed anti-platelet drug after stroke

17
Preventing StrokesThe National Perspective

• Professor Mike Pringle
• Gloucester PCCAG Stroke Study Day
• 30th November 2005