Opinion of New Zealand physicians on management of acute ischaemic stroke:results of a national survey

Background: Randomised trials have evaluated various treatments for acute i schaemic stroke, but it is unclear how the results of these studies are use d in everyday practice. Aims: To obtain the opinions of physicians on the management of acute ischa emic stroke. Methods: A questionnaire was sent to 368 New Zealand Fellows of the Royal A ustralasian College of Physicians. The survey included questions about the availability of hospital services for stroke patients, management of acute ischaemic stroke and opinion on the efficacy of treatments used in acute is chaemic stroke. Results: Of the 293 physicians who responded to the questionnaire, 171 mana ged patients in the first week after stroke. Forty-seven per cent of these physicians were general physicians. Ninety-five per cent usually managed th ese patients in a general medical ward. Only five physicians admitted patie nts to an acute stroke unit and only 57% considered acute stroke units were beneficial. Aspirin was usually or sometimes used for patients with acute ischaemic stroke by 92% of physicians, intravenous heparin by 43%, low-dose subcutaneous heparin by 41%, low-molecular-weight heparin by 25% and tissu e-plasminogen activator (t-PA) by 3%. Two thirds considered that aspirin wa s definitely beneficial, but most were uncertain about the efficacy of intr avenous heparin, low-dose subcutaneous heparin, low-molecular-weight hepari n and t-PA. Sixty-two per cent were prepared to begin aspirin and 21% subcu taneous heparin before computerised tomography (CT). Twenty-three per cent used anti-hypertensive treatment in the first few hours after an ischaemic stroke. Conclusions: Several common deficiencies in the management of acute ischaem ic stroke were identified. The widespread lack of stroke units, use of aspi rin and heparin before CT, and lowering of blood pressure after an acute is chaemic stroke differed from accepted guidelines. Many physicians used hepa rin despite lack of evidence from randomised trials that it is beneficial. The development of stroke units and the appointment of physicians with a sp ecial interest in the management of stroke may improve the management of pa tients with acute stroke.