Follow-Up in Primary Care After Ischemic Stroke – Insights From the Nor-COAST Study

Ingvild Svorkdal Sande,1,* Kamilla Lind Helgheim,1,* Ingvild Saltvedt,2,3 Tove GarÃ¥sen Røsstad,4 Olav Spigset,5,6 Hanne Ellekjær,2,7 Mari Nordbø Gynnild1,7,8 1Department of Circulation and Medical Imaging, Faculty of Medicine and Health Science, NTNU – Norwegian University of Science and Technology, Trondheim, Norway; 2Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Science, NTNU – Norwegian University of Science and Technology, Trondheim, Norway; 3Department of Geriatric Medicine, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway; 4Department of Health and Welfare Services, Trondheim, Norway; 5Department of Clinical Pharmacology, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway; 6Department of Clinical and Molecular Medicine, NTNU – Norwegian University of Science and Technology, Trondheim, Norway; 7Stroke Unit, Department of Internal Medicine, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway; 8Clinic of Cardiology, St. Olavs Hospital, Trondheim, Norway*These authors contributed equally to this workCorrespondence: Mari Nordbø Gynnild, Clinic of Cardiology, St. Olavs Hospital and Department of Circulation and Medical Imaging, Faculty of Medicine and Health Science, Norwegian University of Science and Technology, St. Olavs Hospital HF, Clinic of Cardiology, Post box 3250, Torgarden, Trondheim, 7006, Norway, Tel +4741504565, Email [email protected]: There is limited information on follow-up routines for adequate poststroke care after discharge from hospital.Purpose: This study aimed to assess the likelihood of general practitioner (GP) follow-up within 18 months after an ischemic stroke and to identify clinical factors influencing follow-up frequency.Patients and Methods: Home-dwelling patients admitted to St. Olavs University Hospital with ischemic stroke between 2015 and 2017 were included. Follow-up was assessed by linkage to administrative health data, tracking GP visits over the 18-month period post discharge.Results: In total, 278 of the 302 patients included (92%) had at least one consultation, with a mean time to first consultation of 64 days (SD 96). Of these 278 patients, the cumulative probability of a consultation within 30, 90, 365, and 540 days was 56%, 81%, 96%, and 100%, respectively. The mean number of consultations during the 18-month follow-up was 6.2 (SD 6.7). Factors associated with a lower probability of consultation within the first 90 days included use of home care services (HR 0.56, 95% CI 0.41– 0.77), disability (HR 0.70, 95% CI 0.61– 0.79), frailty (HR 0.82, 95% CI 0.72– 0.94), and cognitive impairment (HR 0.85, 95% CI 0.75– 0.97). Additionally, older age (coefficient − 0.09 per year, 95% CI − 0.16 to − 0.02), use of home care services (coefficient − 2.34, 95% CI − 4.52 to − 0.15), and cognitive impairment (coefficient − 0.77, 95% CI − 1.46 to − 0.09) were associated with fewer consultations.Conclusion: Most patients had at least one GP consultation within 18 months poststroke. However, vulnerable patients with advanced age, frailty, disability, and cognitive impairment may be at risk of suboptimal follow-up after ischemic stroke.Keywords: ischemic stroke, general practice, primary care, cardiovascular prevention, secondary prevention