Title : Prevalence of undiagnosed risk factors in patients with first ever ischemic stroke treated at MUHC
Abstract:
Introduction: Undiagnosed risk factors (URF) defined as risk factors newly diagnosed during inpatient evaluation for stroke are a missed opportunity for primary stroke prevention; we sought to determine the prevalence of URF among first ever ischemic stroke (IS) cases seen at MUHC.
Methods: All first ever acute ischemic strokes among the adult age > 18 population treated at McGill University Health Center (MUHC) by screening the medical records for the patients seen in stroke clinic from 2014-2017. We evaluated the prevalence of undiagnosed diabetes mellitus (DM), hypertension (HTN), hyperlipidemia (HLD), atrial fibrillation (AF), smoking status, obstructive sleep apnea(OSA), coronary artery disease(CAD), peripheral artery disease (PAD) and transient ischemic attack (TIA) among patients with incident (IS). Determination of URF was based on treating physician’s documentation of newly diagnosed RF.We also evaluated the association between URF and if the patients has a family doctor or not by including the post code data to see if there are underserved area as well.
Results: Among 610 patients 58% were male, 42 % female with mean age 65 (56-76). We found total risk factors versus undiagnosed risk factors as following respectively, HTN 59.2% vs 6.2%, DM 26.7% vs 0.1%, HLD 58% vs 14.3%, A.fib 15% vs 1.6%, smoking 16.7%, OSA 4.4%, CAD 14.9%, PAD 0.98%, TIA 3.8%, among the cases with undiagnosed risk factors we found 30.9 % who had no family doctor HTN 36.8%, DM 100%, HLD 27.6%, A fib 0.3 %. We investigated the correlation between area code/ no family doctor and /undiagnosed risk factors as following area 1/18.6%/16.7%, area 2/29%/48.6%, area 3/24.5%/2.4%, area 4/23%/4.8%, area 5/32.4%/9.5% and area 6/24%/23.8%
Conclusion: One in four patients with first ever ischemic stroke had at least one URF at the presentation, one in three of them had no family doctor that more in underserved area. That reinforce the primary prevention for the risk factors with the importance of having a family doctor including underserved area to improve early detection and treatment.
