Diagnosis and initial management of stroke and transient ischemic attack across UK health regions from 1992 to 1996 - Experience of a national primary care database

Background and Purpose-The aim of this study was to establish the differenc e in burden of cerebrovascular disease across the different health regions of the United Kingdom and to determine whether the initial management of ne w cases of stroke and transient ischemic attack (TIA) was uniform across th e United Kingdom. Methods-The General Practice Research Database (GPRD) is a national databas e used for epidemiological studies. This was a cohort study identifying inc ident cases of stroke and TIA over a 5-year study period between 1992 and 1 996. The population studied was patients registered with general practition ers contributing to the GPRD across the different health regions of the Uni ted Kingdom. Outcome measures were new diagnoses of stroke and TIA, new pre scriptions for antiplatelet and anticoagulant agents, and referrals made fo r specialist opinion. Results-The age-adjusted annual incidence rate across all regions was 151 p er 100 000 for stroke and 190 per 100 000 for TIA. There was almost a 2-fol d difference in the incidence of cerebrovascular disease between the region s. The management of stroke and TIA in terms of antiplatelet prescription a nd of referral onward for further opinion to hospital specialists varied si gnificantly between regions. Conclusions-Reported stroke and TIA incidence on the GPRD was comparable to that of other European studies. There were striking regional differences i n the incidence of disease. The primary care management, both in prescripti on and referral rates, varied significantly between the different regions. There was a marked underuse of antiplatelet and anticoagulant agents, and r eferral rates for specialists' opinions were low.