London, United Kingdom 2013 Poster Session Blue Cerebrovasc Dis 2013; 35 (suppl 3)1-854 757 777 Stroke prevention Device-Based Strategy for Secondary Prevention of Stroke in Non-valvular Atrial Fibrillation Patients H. Sievert1, B. Whisenant2, S. Kar3, V. Reddy4, S. Doshi55 CardioVascular Center Frankfurt, Frankfurt, GERMANY1, Intermountain Medical Center, Murray, USA2, Cedars Sinai Medical Center, Los Angeles, USA3, Mount Sinai School of Medicine, New York, USA4, St Johns Heath Center, Santa Monica, USA5 For high risk patients with non-valvular atrial fibrillation, LAA closure is a device-based strategy for the prevention of stroke. This strategy was evaluated in the PROTECT AF and CAP trials with the implantation of the WATCHMAN device in patients who had a previous stroke or TIA. Patients in the PROTECT AF and CAP trials who had a history of stroke or TIA at baseline were compared via proportional hazards models for the studies’ composite primary efficacy endpoint (stroke, systemic embolism, or cardiovascular/unknown death). Separate analyses were run compar-ing device patients between trials and the device patients from the CAP study to the warfarin control patients from PROTECT AF. Rates are expressed as percent of patients experiencing the event per year. In PROTECT AF, there were 131 secondary prevention patients randomized in the study; 82 to de-vice and 49 to warfarin following the 2:1 randomization allocation; the average follow-up was 3.7 years. In CAP, there were 172 secondary prevention patients; the average follow-up was 2.4 years. For PROTECT AF, the rate for the primary efficacy endpoint was 4.7%/y for the device group and 7.2%/y for the warfarin group (HR=0.66, 95% CI 0.30–1.45). For the CAP device patients, the rate for the primary efficacy endpoint was 3.6%/y. Comparing the CAP device patients to the PRO-TECT AF control patients, there was further evidence of a favorable benefit for the device in the primary endpoint (HR=0.53, 95% CI 0.23–1.25). Combining all device patients (PROTECT AF and CAP), the hazard ratios (95% CI) comparing against control were 0.57 (0.28-1.13) for the primary efficacy endpoint. Patients with previous stroke or TIA face a high risk of recurrent stroke even when treated with warfarin. The benefit relative to control was seen in both PROTECT AF and CAP patients. These results demonstrate that LAA closure is a reasonable alternative to oral anticoagulation for the sec-ondary prevention of stroke. 778 Stroke prevention Detailed instructions for cholesterol and glucose objective levels and adherence to secondary prevention control strategies C. TEJERO JUSTE1, A. SULLER.MARTI2, J.L. CAMACHO3, C. PEREZ LAZARO4, J.A. MAU-RI LLERDA5, E. MOSTACERO MIGUEL6 HOSPITAL CLÍNICO UNIVERSITARIO LOZANO BLESA, ZARAGOZA, SPAIN1, HOS-PITAL CLÍNICO UNIVERSITARIO LOZANO BLESA, ZARAGOZA, SPAIN2, HOSPITAL CLÍNICO UNIVERSITARIO LOZANO BLESA, ZARAGOZA, SPAIN3, HOSPITAL CLÍNICO UNIVERSITARIO LOZANO BLESA, ZARAGOZA, 4, HOSPITAL CLÍNICO UNIVERSITARIO LOZANO BLESA, ZARAGOZA, SPAIN5, HOSPITAL CLÍNICO UNIVERSITARIO LOZANO BLESA, ZARAGOZA6 Background: Since patients with ischemic stroke are at high-risk for recurrence and for cardiovascu-lar morbidity and mortality, preventive measures aimed to reduce cardiovascular adverse events are advocated in the current guidelines. Reduced adherence and compliance to discharge instructions and protocols could significantly influence the ability of any stroke prevention strategy. The authors sought to determine whether use of detailed orders would be associated with improvement in stroke care. Methods: All patients with a discharge diagnosis of ischemic stroke were identified from our registry of hospital discharge. Patient charts were reviewed with regard to the completeness of the discharge order of cholesterol levels controls regimen, and vascular risk factor determinations at 12 months post discharge. Results: Of 275 patients hospitalized with acute ischemic stroke, almost all had orders for Primary Practician but only 92 (33,4%) had detailed instructions for cholesterol and glucose objective levels in the discharge inform. At 12 months post stroke, of the 92 patients with detailed objective values, 61 (66,3%) had at least one cholesterol level determination and of the 183 patients without detailed objective values,120 (65,6%). CONCLUSIONS Implementation of an intervention based upon incorporation of detailed instruc-tions for cholesterol and glucose objective levels in the hospital discharge inform was not associated with improvement in adherence to secondary prevention control strategies.
Karger_ESC London_2013
To see the actual publication please follow the link above