P3458Stroke prevention: from policy to clinical practice in the US and Europe

Abstract

Background: Stroke is a leading cause of death and disability globally. Up to 80% of strokes are preventable. If stroke risk factors are detected early, preventive measures can be offered to patients in a timely manner. Purpose(s): There are several ways in which cardiovascular prevention can be addressed, such as through raising awareness and screening programs. This study aims to investigate whether these are actually being implemented on the ground. Method(s): This study used primary and secondary research to assess how 12 countries: Belgium, France, Germany, Italy, Netherlands, Norway, Russia, Spain, Sweden, Turkey, UK and USA, address stroke risk factors in primary care. We developed a conceptual framework to evaluate different aspects of stroke prevention practices. The indicators captured the existence of awareness campaigns, the use of evidence-based national guidelines, the development of stroke registries and screening practices for hypertension and atrial fibrillation. The primary research surveyed 600 physicians - 50 physicians in each country - to identify the proportion of patients screened for blood pressure and atrial fibrillation. The indicators were constructed to take a composite approach to identifying country performance and where any improvements could be made. Result(s): 7 out of the 12 countries sampled have evidence-based national guidelines in place around managing non-communicable disease in primary care. More significant gaps exist in areas such as initiatives to raise awareness around stroke; only 3 of the countries observedWorld Stroke Day in 2016 and 7 countries do not have a national stroke registry. In clinical practice, 7 out of the 12 countries reported that less than 20% of patients: median 18% (range: 8% to 58%) over the age of 40 who were not already being monitored for hypertension, were screened by blood pressure testing. Even fewer are screened for atrial fibrillation; in 11 out of the 12 countries less than 20% patients: median 14% (range: 5% to 42%) over the age of 65 were screened using pulse palpation or electrocardiogram. Conclusion(s): The findings show that there is contrast in how stroke prevention is addressed across countries and there is room for improvement even in the more advanced economies. Although national evidence-based guidelines are generally in place, screening for hypertension and atrial fibrillation is not systematically performed in clinical practice. Additionally, more efforts are needed to develop national stroke registries and improve education and population awareness around stroke risk factors.