Control of cardioembolic stroke prevention in patients with pre-existing embolic cardiopathy

Abstract

BACKGROUND: Cardioembolic stroke accounts for about 23% of all ischemic strokes and is strongly associated with a higher mortality rate and worse outcomes, though it is largely avoidable with appropriate prevention measures and strict control of the causative embolic cardiopathies. Atrial fibrillation is the main cause of cardioembolic stroke, followed by ischemic cardiopathies and heart valve disease (rheumatic and prosthetic valves). Although recent literature thoroughly outlines several well-evidenced preventative treatments, the incidence of stroke is not decreasing. Many studies show that this fact could be associated with poor control and administration of these stroke prevention measures. This study is designed to determine the proportion of cardioembolic stroke patients with a pre-existing embolic cardiopathy who are not receiving an optimal preventive treatment. Patient’s clinical profile, associated risk factors, mortality rate, length of hospital stays and socioeconomically impact are also analyzed in order to provide up-dated data of the importance of this problem. Finally, this study aims to identify the probable deficiencies in primary and secondary prevention in order to determinate the elements that would help to improve the preventive programs. OBJECTIVE: To study the adequacy of treatment calculating the proportion of patients with cardioembolic stroke and pre-existing embolic cardiopathies whose preventive treatment was not appropriate, and to identify their clinical profile, the mortality rate and the grade of disability due to stroke, and the healthcare impact. METHODS: Medical records of 250 patients admitted to Doctor Josep Trueta University Hospital and Santa Caterina Hospital from Girona between 2010 and 2015 with a discharge diagnosis of cardioembolic stroke and a known history of a cardiac embolic source are reviewed in order to describe stroke patient’s profile, to analyze their risk of stroke based in the CHA2DS2VASC score and the risk of major bleeding with the HAS-BLED score, and to qualify their stroke preventive treatment employed before having the cardioembolic infarction. According to the indications of the most recently validated guidelines, patients are divided in two groups: 1. Patients with adequate preventive treatment. 2. Patients with non-optimal preventive treatment. If patients were treated with vitamin K antagonists, the values of the international normalized ratio (INR) of 6 months prior to stroke are also collected in order to calculate the therapeutic time in range and quantify the level of anticoagulation control. Finally the mortality rate, the disability grade based on Rankin score, the length of stays at the hospital and the economical healthcare impact are also determined