Abstract WP186: The Quality of Secondary Prevention after Stroke or Transient Ischemic Attack is Worse in Survivors With Disability

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Introduction: Severity of stroke impacts functional outcomes after stroke, but the role of this disability on secondary prevention is unclear. We investigated the effect of disability status on secondary prevention outcomes, such as the management of risk factors, knowledge regarding secondary prevention, and long-term unmet needs. Methods: Post-hoc analysis of a clinical trial of community-dwelling adults with stroke/TIA in Melbourne, Australia. Demographic/clinical data were obtained from hospital records, while standardised assessments were conducted for disability, cardiovascular risk, and mood. Disability was defined using the modified Rankin Scale (mRS): no disability (mRS=0), no significant disability (mRS=1), or slight to severe disability (mRS 2-5). Two-year outcomes included the standardized cardiovascular Framingham risk score, unmet needs, and knowledge of risk factors and medications prescribed for secondary prevention. Multivariable regression models were used to determine the effect of disability status on outcomes. Results: From January 2010 to November 2013, 563 survivors of stroke/TIA were recruited: median age 70.1 years, 65% males, 79% ischemic stroke, and 29% with no disability. After a 2-year follow-up, 86% provided outcome data. In the multivariable regression analyses, when compared to participants with no significant disability, those with slight/severe disability had greater cardiovascular risk scores (odds ratio 1.33, 95% CI 1.00-1.76). A dose-response effect was found for disability status and long-term unmet needs, with more unmet needs reported among those with no significant disability (incidence risk ratio 1.55, 95% CI 1.21-1.99) or with slight/severe disability (incidence risk ratio 1.64, 95% CI 1.24-2.16), than in those with no disability. We found no effect of disability status on knowledge of risk factors or medications. Conclusions: After a 24-month follow-up, survivors of stroke/TIA with disability had worse risk profiles and more unmet needs than those with no disability, and may benefit from targeted care post-discharge.