Abstract WMP52: Prevalence of Undiagnosed Risk Factors in Patients With First-Ever Ischemic Stroke

Abstract

Introduction: Undiagnosed RF (URF) are a missed opportunity for primary stroke prevention. We sought to determine the prevalence of URF (RF newly diagnosed during inpatient evaluation) among first-ever ischemic stroke (IS) cases within a large, bi-racial population. Methods: Within the population-based Greater Cincinnati/Northern Kentucky (GCNK) stroke study catchment area of 1.3 million, we ascertained all hospitalized first-ever acute IS in 2010 among individuals ≥20 years old through screening of ICD-9 codes 430-436, with all cases verified by study physicians. We evaluated the prevalence of undiagnosed diabetes mellitus (DM), hypertension (HTN), hyperlipidemia (HLD), and atrial fibrillation (AF) among all IS patients and those with each risk factor. We also evaluated the association between URF and insurance status (private, Medicaid/Medicare, or uninsured) for each RF using chi-square tests. Results: There were 1737 first-ever IS cases in the GCNK region in 2010 (55.8% female, 19.5% black, median age 71). Of these, 21% had at least one URF (Table), most commonly HLD (13%) or HTN (6%). Among patients with a given risk factor, 21% of those with HLD, 13% with AF, 9% with DM, and 7% with HTN were undiagnosed prior to inpatient evaluation for first-ever IS. Uninsured individuals (48%) were significantly more likely than those with private (22%) or government (20%) insurance to have at least one URF. Conclusions: One in five IS patients had at least one URF upon presentation with their first-ever stroke, and URF were more prevalent among uninsured individuals. Our data reinforce the importance of screening for URF during IS evaluation and highlight the importance of earlier detection of treatable RF. Future research should evaluate factors that may predict URF, such as insurance status, race, or sex.