뇌졸중 환자의 이차 예방 실태:3차 병원에 입원한 환자를 중심으로

Abstract

Background & Objectives: There have been few studies about the compliance for secondary prevention in patients with stroke. The objective of this study was to assess the perception and compliance for secondary prevention in Korean stroke patients. Methods: This is a cross-sectional study of a prospectively collected data obtained from acute stroke patients admitted during 1-year period. We included patients who 1) had had a stroke (ischemic or hemorrhagic) diagnosed by CT or MRI in the past, or 2) had experienced stroke symptoms with corresponding old lesion on this CT or MRI despite the absence of imaging-confirmed diagnosis in the past. Patients who 1) had had only suspicious symptoms of stroke 2) did not have old lesions identified on the present CT or MRI 3) had old lesions on the present CT or MRI without previous symptoms of stroke (asymptomatic lesion) were excluded. Patients were interviewed using a structured questionnaire, which included the information of prior use of antithrombotics, out-patient clinic follow-up, the management of risk factors (hypertention, diabetics, cardiac disease, hyperlipidemia, smoking, heavy drinking), and recent precipitating factors. As for the compliance of medication and risk factor management, we analyzed the patients who had strokes with identical subtypes (ischemic vs. hemorrhagic) as the previously experienced one. Results: 157 patients met the inclusion criteria, and 115 patients had recurrent strokes with identical sub-types as the previous one (106 ischemic/9 hemorrhagic). Of these 115 patients, 37 (32%) had not had regular out-patient clinic follow-up after the previous stroke. 29% (31/106) of ischemic stroke patients had not received antithrombotics, and 56% (5/9) of hemorrhagic stroke patients had not received anti-hypertensive agents. 22% (21/95) of patients with a history of hypertension had not had regular medication. 83% (34/45) of patients with a history of diabetes had a high (≥7.0%) HbA1C level, and 57% (8/14) of those with a history of hyperlipidemia had a high (≥100 mg/dL) serum LDL cholesterol level at admission. Smoking was maintained in 31 (50%) of 62 smokers. On the contrary, 20% (23/115) of all patients developed a recurrent stroke despite appropriate antithrombotic use and risk management. Conclusions: Our data show that patients’ compliance for the secondary prevention of stroke is generally poor. E ffective strategies are needed to improve the compliance for the secondary prevention of stroke in this society.