Secondary prevention after ischaemic stroke: the ASPIRE-S study.

BACKGROUND: Survivors of ischaemic stroke (IS) are at high-risk for future vascular events. Comprehensive information on the adequacy of secondary prevention after IS is lacking despite the knowledge that appropriate secondary prevention improves long-term patient outcomes. ASPIRE-S (Action on Secondary Prevention Interventions and Rehabilitation in Stroke) aimed to prospectively assess secondary prevention in patients 6 months following IS. METHODS: Consenting patients admitted with IS to three Dublin hospitals were recruited over 1 year, from October 2011. At 6 months post IS a comprehensive assessment was completed, modelled on the EUROASPIRE protocol for evaluation of the adequacy of secondary prevention in post-discharge cardiac patients. This assessment included measurements of blood pressure, body mass index and fasting lipid and glucose profiles. Secondary preventive medications and smoking status were also documented. RESULTS: Three hundred two patients (58 % male) participated, of whom 256 (85 %) were followed-up at 6 months. Mean age was 69 years (range 22-95). At follow-up, 68 % of patients had a BMI >25 kg/m(2) and 16.4 % were still smoking. Almost two-thirds (63.4 %) had a blood pressure >140/90 and 23 % had low-density-lipoprotein >2.5 mmol/L. 28 % of diabetic patients had HbA1c ≥7 %. Ninety seven percent of patients were on anti-platelet and/or anticoagulant therapy. Of those with atrial fibrillation, 82 % were anti-coagulated (mean INR of 2.4). Ninety-five percent were on lipid-lowering therapy and three-quarters were on anti-hypertensive therapy. CONCLUSION: This prospective multi-centre survey of IS patients demonstrated a high prevalence of remaining modifiable risk factors at 6 months post stroke, despite the widespread prescription of secondary preventive medications. There is scope to improve preventive measures after IS (in particular blood pressure) by incorporating evidence-based guidelines into quality assurance cycles in stroke care.</p

SLAN 2007 : Survey of Lifestyle, Attitudes and Nutrition in Ireland. ' One Island - One Lifestyle?' Health and lifestyles in the Republic of Ireland and Northern Ireland : Comparing the population surveys SLAN 2007 and NIHSWS 2005

The information provided here gives a sense of the value of comparing population studies between the Republic and Northern Ireland, albeit incomplete comparisons in this case since the studies were conducted independently. We share enough that is both common and unique in our attitudes, health profiles and health systems to enable fruitful comparisons for both sides. Future opportunities for comparison should be more explicitly incorporated into the planning stages of such studies. We hope that this report will provide a catalyst for joint survey planning, such that information forthcoming can inform and benefit policy and practice in the pursuit of good health and well-being in the coming years in both the Republic of Ireland and Northern Ireland.</p

From Prevention to Nursing Home Care: A Comprehensive National Audit of Stroke Care.

  Background: Many countries are developing national audits of stroke care. However, these typically focus on stroke care from acute event to hospital discharge rather than the full spectrum from prevention to long-term care. We report on a comprehensive national audit of stroke care in the community and hospitals in the Republic of Ireland. The findings provide insights into the wider needs of people with stroke and their families, a basis for developing stroke-appropriate health strategies, and a global model for the evaluation of stroke services. Methods: Six national surveys were completed: general practitioners (prevention and primary care), hospital organisational and clinical audit of 2,570 consecutive stroke admissions (acute and hospital care), allied health professionals and public health nurses (discharge to community care), nursing homes (needs of patients discharged to long-term care), and patient and carers (post-hospital phase of rehabilitation and ongoing care). Results: The audit identified substantial deficits in a number of areas including primary prevention, emergency assessment/investigation and treatment in hospital, discharge planning, rehabilitation and ongoing secondary prevention, and communication with patients and families. There was a lack of coordination and communication between the acute and community services, with a dearth of therapy services in both home and nursing home settings. Conclusion: This multi-faceted national stroke audit facilitated multiple perspectives on the continuum of stroke prevention and care. An overall synthesis of surveys supports the development of a multidisciplinary perspective in planning the development of comprehensive stroke services at the national level, and may assist in regional and global development of stroke strategies.</p

SLAN 2007: Survey of Lifestyle, Attitudes & Nutrition in Ireland: Executive Summary

This report presents the main findings from the 2007 Survey of Lifestyle, Attitudes and Nutrition in Ireland (SLÁN 2007). This is the third and largest SLÁN survey and the first to include those participating in languages other than English and Irish. Previous studies were carried out in 1998 (Friel et al, 1999) and 2002 (Kelleher et al, 2003). Both these reports are available on the website www.healthpromotion.ie/publications. The main SLÁN 2007 survey was conducted through face-to-face interviews. There were two sub-group studies involving (i) measurement of height, weight and waist circumference(sub-group of younger respondents) and (ii) a detailed physical examination (sub-group of older respondents). The overall aim was to provide nationally representative data on the general health, health behaviours and health service use of adults living in Ireland. The two sub-group studies aimed to provide vital information regarding the health risk profiles of younger and older adults. The themes of SLÁN 2007 were selected based on current national policy and service priorities. Key documents were consulted, including the National Health Strategy, Quality and Fairness (Department of Health and Children, 2001); the National Health Promotion Strategy (Department of Health and Children, 2000); and the Chief Medical Officer’s 4th Annual Report (Department of Health and Children, 2005). Further consultation across the research consortium, funder and Advisory Group produced a prioritised and manageable set of items to assess. A key requirement was to provide a core set of national population health data that would enable comparison within study sub-groups (gender, age and social class), across health service regions within the Health Service Executive (HSE), with other key comparison populations (particularly Northern Ireland) and with previous SLÁN surveys. The SLÁN 2007 survey was funded by the Health Promotion Policy Unit of the Department of Health and Children. The survey and analyses were carried out by the SLÁN 2007 Consortium, consisting of the Royal College of Surgeons in Ireland (RCSI), the National University of Ireland, Cork (UCC), the National University of Ireland, Galway (NUIG) and the Economic and Social Research Institute (ESRI).</p

SLAN 2007: Survey of Lifestyle, Attitudes & Nutrition in Ireland: Main Report

This report presents the main findings from the 2007 Survey of Lifestyle, Attitudes and Nutrition in Ireland (SLÁN 2007). This is the third and largest SLÁN survey and the first to include those participating in languages other than English and Irish. Previous studies were carried out in 1998 (Friel et al, 1999) and 2002 (Kelleher et al, 2003). Both these reports are available on the website www.healthpromotion.ie/publications. The main SLÁN 2007 survey was conducted through face-to-face interviews. There were two sub-group studies involving (i) measurement of height, weight and waist circumference(sub-group of younger respondents) and (ii) a detailed physical examination (sub-group of older respondents). The overall aim was to provide nationally representative data on the general health, health behaviours and health service use of adults living in Ireland. The two sub-group studies aimed to provide vital information regarding the health risk profiles of younger and older adults. The themes of SLÁN 2007 were selected based on current national policy and service priorities. Key documents were consulted, including the National Health Strategy, Quality and Fairness (Department of Health and Children, 2001); the National Health Promotion Strategy (Department of Health and Children, 2000); and the Chief Medical Officer’s 4th Annual Report (Department of Health and Children, 2005). Further consultation across the research consortium, funder and Advisory Group produced a prioritised and manageable set of items to assess. A key requirement was to provide a core set of national population health data that would enable comparison within study sub-groups (gender, age and social class), across health service regions within the Health Service Executive (HSE), with other key comparison populations (particularly Northern Ireland) and with previous SLÁN surveys. The SLÁN 2007 survey was funded by the Health Promotion Policy Unit of the Department of Health and Children. The survey and analyses were carried out by the SLÁN 2007 Consortium, consisting of the Royal College of Surgeons in Ireland (RCSI), the National University of Ireland, Cork (UCC), the National University of Ireland, Galway (NUIG) and the Economic and Social Research Institute (ESRI).</p