LOCAL CONFIDENTIAL INQUIRY INTO AVOIDABLE FACTORS IN DEATHS FROM STROKE AND HYPERTENSIVE DISEASE

Objective-To audit avoidable deaths from stroke and hypertensive disea se. Design-Details of care before death were obtained from general pra ctitioners and other doctors, anonymised, and assessed by two experts against agreed Minimum standards of good practice for detecting and ma naging hypertension. Setting-Health authority with population of 25000 0. Subjects-All patients under 75 years who died of stroke, hypertensi ve disease, or hypertension related causes during November 1990 to Oct ober 1991. Main outcome measures-Presence of important avoidable facto rs and departures from minimum standards of good practice. Results-Ade quate information was obtained for 88% (123/139) of eligible cases. Ag reement between the assessors was mostly satisfactory. 29% (36/123, 95 % confidence interval 21% to 37%) of all cases and 44% (36/81, 34% to 55%) of those with definite hypertension had avoidable factors that ma y have contributed to death. These were most commonly failures of foll ow up and continuing smoking. Assessment against standards of minimum good practice showed that care was inadequate but not necessarily deem ed to have contributed to death, in a large proportion of patients wit h definite hypertension. Common shortcomings were inadequate follow up , clinical investigation, and recording of smoking and other relevant risk behaviours. Conclusions-This method of audit can identify shortco mings in care of patients dying of hypertension related disease.