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22. European Stroke Conference 21 Stroke prevention B 17:50 - 18:00 SUBOPTIMAL LIPID MANAGEMENT IN ISCHAEMIC STROKE AND TIA PA-TIENTS- THE NORTH DUBLIN POPULATION STROKE STUDY D. Ní Chróinín1, C. Ní Chróinín2, E.L. Callaly3, N. Hannon4, L. Kelly5, M. Marnane6, Á. Mer-wick7, Ó. Sheehan8, G. Horgan9, J. Duggan10, L. Kyne11, E. Dolan12, A. Moore13, D. Williams14, P.J. Kelly15 Neurovascular Unit for Translational and Therapeutics Research, Mater University Hos-pital/ University College Dublin, Dublin, IRELAND1,School of Medicine, University Col-lege, Cork, Cork, IRELAND2, Neurovascular Unit for Translational and Therapeutics Research, Mater University Hospital/University College Dublin, Dublin, IRELAND3, Neurovascular Unit for Translational and Therapeutics Research, Mater University Hospital/University College Dublin, Dublin, IRELAND4, Neurovascular Unit for Translational and Therapeutics Research, Mater University Hospital/University College Dublin, Dublin, IRELAND5, Neurovascular Unit for Translational and Therapeutics Research, Mater University Hospital/University College Dublin, Dublin, IRELAND6, Neurovascular Unit for Translational and Therapeutics Research, Mater University Hospital/University College Dublin, Dublin, IRELAND7, Neurovascular Unit for Translational and Therapeutics Research, Mater University Hospital/University College Dublin, Dublin, IRELAND8, Neurovascular Unit for Translational and Therapeutics Research, Mater University Hospital/University College Dublin, Dublin, IRELAND9, Neurovascular Unit for Translational and Therapeutics Research, Mater University Hospital/ University College Dublin, Dublin, IRELAND10, Neurovascular Unit for Translational and Therapeutics Research, Mater University Hospital/University College Dublin, Dublin, IRE-LAND11, Connolly Hospital, Dublin, IRELAND12, Beaumont Hospital, Dublin, IRELAND13, Beaumont Hospital/Royal College of Surgeons, Ireland, Dublin, IRELAND14, Neurovascular Unit for Translational and Therapeutics Research, Mater University Hospital/University Col-lege Dublin, Dublin, IRELAND15 Background: Few population-based studies have assessed lipid adherence to international guidelines for primary and secondary prevention in stroke/TIA patients. Our aim was to as-sess guideline adherence in the North Dublin Population Stroke Study. Methods: All ischaemic stroke and TIA patients were prospectively ascertained over one year (2006), using overlapping ‘gold-standard’ methods. Individual LDL targets were calculated based on pre-event risk pro-file. Adherence was assessed to NCEP III 2002, NCEP report 2004 and ESC 2003 guidelines, at presentation and at discharge from hospital/clinic. Results: Of 616 stroke/TIA patients, to-tal cholesterol was measured in only 76.5% (471/616), and LDL in only 60.1% (370). Lipid measurement was associated with male gender, younger age, lower pre-event and post-event Rankin scores (all p£0.005). At presentation, 32.7% were on lipid-lowering therapy (LLT; 98.5% statin). By NCEP III guidelines, LDL met target in only 54.1% (200/370; Table). Tar-get compliance was associated with prior stroke (p=0.02), diabetes (p=0.04), hypertension (p=0.03), atrial fibrillation (p=0.01), LLT use (p<0.001), and higher LDL target threshold (p=0.001). 29.2% of LLT users were above target levels. By NCEP III criteria, 21.6% (53/245) of stroke/TIA patients for whom LLT was recommended were not on LLTs. By the stricter 2004 NCEP goals, only 44.9% of patients met target goals at the time of stroke/TIA. ESC guideline compliance was similar. At discharge, 75.5% of stroke/TIA patients were on LLTs. By NCEP III criteria, of patients with LDL >2.59mmol/l, 15.3% were not on LLT at discharge. Results were similar when ESC thresholds were applied (2.5mmol/l). No association was observed be-tween achieving goal LDL and with fatality or stroke recurrence at 2 years. Conclusions: Pri-mary and secondary prevention were sub-optimal in this large population-based cohort, high-lighting the need for improved lipid management in patients at risk of stroke and TIA. 20 Stroke prevention B 17:40 - 17:50 Secondary prevention in the rehabilitation setting D.A. Cadilhac1, T. Purvis2, E. Ritchie3, M. Kilkenny4, C. Price5, K. Hill6, E. Lalor7 On behalf of the National Stroke Foundation and the National Stroke Audit Collaborative Insti-tutions Translational Public Health Unit, Stroke & Ageing Research Centre, Southern Clinical School, Monash University, Melbourne, AUSTRALIA1,Translational Public Health Unit, Stroke & Ageing Research Centre, Southern Clinical School, Monash University, Melbourne, AUSTRALIA2, National Stroke Foundation, Melbourne, AUSTRALIA3, Translational Public Health Unit, Stroke & Ageing Research Centre, Southern Clinical School, Monash University, Melbourne, AUSTRALIA4, National Stroke Foundation, Melbourne, AUSTRALIA5, National Stroke Foundation, Melbourne, AUSTRALIA6, National Stroke Foundation, Melbourne, AUS-TRALIA7 Background Recommendations from international guidelines emphasise the importance of secondary pre-vention management for stroke. Biennial national audits of Australian stroke inpatient rehabili-tation hospitals were first published in 2008 and report on adherence to recommendations in the national clinical guidelines. It is unclear how well secondary prevention recommendations are being adhered to in Australian rehabilitation hospitals. Feedback to hospitals following audit may encourage change in practice. Aims To describe changes in adherence to recommended stroke rehabilitation secondary prevention practices in Australia between the 2010 and 2012 audit cycles. Methods For each audit cycle, clinicians at each participating hospital retrospectively audited up to 40 consecutive stroke admissions from the previous calendar year. Standardized training, data dic-tionary and support were provided by National Stroke Foundation staff. Descriptive bivariate comparisons are presented. Results Overall, 5806 patients were audited; 2985 (96 hospitals) for 2010 cycle, 2821 (101 hospitals) for 2012 cycle. Patient characteristics were similar for each period (mean age 73, 54% males, 77% ischaemic strokes for 2010 and 76% for 2012). Average length of stay was the same (23 days). Improvements in prescription of secondary prevention medications were found. These included antithrombotics (97% 2012, 89% 2010, p<0.001) and lipid lowering medication if an ischaemic stroke (84% 2012, 79% 2010, p<0.001); and blood pressure lowering medica-tions on discharge (85% 2012, 82% 2010 p=0.003). Fewer patients were provided with advice about lifestyle and risk factor modification in 2012 compared to 2010 (34% 2012, 42% 2010 p<0.001). Conclusion Adherence to secondary stroke prevention medication prior to discharge from inpatient reha-bilitation improved between audit cycles. Continued focus on health promotion and education about behaviour change are needed. 166 © 2013 S. Karger AG, Basel Scientific Programme


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