Benefit Expectations and Neuroprotective Prescribing for Acute Ischemic Stroke in China

Background: Neuroprotective therapies are frequently used for acute ischemic stroke in China. We examined associations of neurologists? self-rated familiarity, perceived importance, and benefit expectations with reported prescribing frequency. Methods: A hospital-based quota survey recruited attending-level or senior neurologists involved in acute ischemic stroke care across mainland China from May 27 to July 16, 2025. High-frequency use was defined as prescribing neuroprotective therapy to at least 60% of patients. High familiarity and importance were ratings of 4 or 5 on 5-level scales; consistently high benefit expectations required ratings of 4 or 5 in all 4 scenarios. Modified Poisson generalized estimating equations estimated adjusted prevalence ratios (PRs) with hospital-clustered robust standard errors. Results: Among 1982 neurologists from 251 hospitals, 1007 (50.8%) were men and 1745 (88.0%) practiced in tertiary hospitals. High-frequency use was reported by 1596 respondents (80.5%), high familiarity by 1006 (50.8%), and consistently high benefit expectations by 1290 (65.1%). Lower familiarity with high-frequency use was reported by 743 respondents (37.5%). High familiarity (adjusted PR, 1.053; 95% CI, 1.007?1.102), high perceived importance (adjusted PR, 1.294; 95% CI, 1.148?1.458), and consistently high benefit expectations (adjusted PR, 1.198; 95% CI, 1.131?1.269) were associated with high-frequency use after adjustment for demographic and professional characteristics. Conclusions: Frequent self-reported neuroprotective prescribing coexisted with lower self-rated familiarity in a substantial subgroup. Familiarity, perceived importance, and benefit expectations were associated with prescribing frequency. These cross-sectional, class-level measures cannot establish prescribing appropriateness or causality. Studies linking drug-specific observed prescribing to indications and patient outcomes are needed.