The association of a streamlined and updated stroke protocol with improved secondary prevention and outcome

Background: Stroke recurrence rates following an index event remain high compared with the baseline population. Evidence-based stroke treatments reduce this risk. Aims: To determine the effect of an updated and streamlined hospital stroke guideline on prescribing practices and stroke recurrence rates at 3 months. Methods: Hospital registries were searched for ICD-10 codes for transient ischaemic attack (TIA) and ischaemic stroke between July 2019 and July 2020. Data on patient demographics, discharge documentation, and other outcomes of interest were dichotomised into pre and post-intervention. Results: 396 patients were identified. There was a significant reduction in the stroke recurrence rate at 3 months post guideline update (8.3% vs 2.2%, OR 0.24, p<0.01). There were significant improvements in prescriptions for statins (66.5% vs 81.2%, p≤0.01) and antihypertensives (40.7% vs 50.7%, p=0.05), and documentation of lipid and blood pressure targets in discharge letters. There was a trend towards greater use of dual antiplatelet therapy (25.2% vs 34.1%, p=0.057). Conclusion: In this audit, we found an association between the guideline update and improved patient outcomes and prescribing practices. We were unable to directly attribute the reduction in stroke recurrence to any single factor. This may be a chance finding and warrants investigation in other settings. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement This study did not receive any funding ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: The ethics committe of the Health and Disability Ethics Committee of New Zealand waived ehtical approval for this work I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes All data produced in the present study are available upon reasonable request to the authors