Self-perceived and Actual Risk of Further Stroke in Patients with Recurrent Stroke or Recurrent Transient Ischemic Attack in Thailand

Abstract

Background: The correct perception in patients of their future risk of recurrent stroke may lead to changes in behavior and to successful secondary prevention of stroke. The primary aim was to compare patients’ perceived risk with the actual risk of further stroke. Methods: This cross-sectional study was carried out in 2 tertiary hospitals in northeast Thailand. Self-perceived risk of further stroke was assessed by validated questionnaire and categorized as low, medium, or high. Actual risk was calculated using Stroke Prognosis Instrument II which classified patients into 3 risk groups: low, medium, and high. The level of agreement between perceived and actual risk was analyzed using the kappa statistic. Results: One hundred forty patients with recurrent stroke or recurrent transient ischemic attack were enrolled (age 65.6 ± 11.3 years, mean ± standard deviation). Most patients wrongly estimated their risk of further stroke: 43.6% of patients underestimated and nearly one fifth (17.1%) overestimated their risk; the kappa coefficient was .08. Patients with hypertension and diabetes were more likely to underestimate their risk of recurrent stroke. The only characteristic found to be significantly associated with perceived high risk was the level of independence in activities of daily living: patients with Barthel index less than or equal to 60 were more likely to perceive themselves as having high risk for recurrent stroke. Conclusions: Most patients underestimated their risk for further stroke. Implementation of a comprehensive care program to communicate to patients their future risk of stroke and to modify their risk factors is warranted in Thailand.