Background and objective: Data on implementation of stroke guidelines are scarce in Spain. We assessed the quality of diagnosis and prevention measures at discharge in patients admitted to hospital for acute cerebral infarction (ACI) in Spain.
Patients and method: Independent audit of clinical records on 1,448 consecutive patients admitted to Spanish hospitals for an ACI, performed in a stratified-random sample of 30 public Spanish hospitals. The number of records evaluated per hospital was adjusted by hospital size. Information collected included demographic variables, cerebrovascular risk factors (CRF), family and personal history of cerebrovascular disease, prior cognitive impairment, subtype of infarction, use of functional and cognitive scales, supplementary investigations performed during hospital stay, recommendations, and treatments prescribed at discharge.
Results: No information about the ACI etiology was found in 46% of the clinical records. Information on prior vascular diseases was recorded in 69%. Information about pre-existing cognitive impairment was found only in 27%. The use of neurological scales was reported in only 21.1% of the cases. CRF information was observed in 99.2% of the cases. Antihypertensives and antidiabetic treatment were prescribed in 73.2% and 70% of hypertensives and diabetic patients, respectively. Lipid lowering drugs were prescribed in 57.3% of dislipemic patients. Antithrombotic treatment was prescribed in 82% of patients (antiplatelets 77.5%, oral anticoagulants 18.4%, combined therapy 4.1%). Information regarding CRF therapeutic goal attainments was scarcely registered.
Conclusions: There is an inadequate adherence to guideline recommendations for the diagnosis and prevention of ACI in Spain. Particularly, the information included in the history regarding cerebrovascular disease, cognitive evaluation, characterization of cerebral infarction, and treatment and control of CRF should be improved.