Secondary Prevention Gaps at Recurrent Ischemic Stroke Admission: A Nationwide Registry Study
Year: 2026
Type: article
Study design: Observational Study
Abstract: Background and Purpose: Recurrent ischemic stroke is a sentinel audit point for secondary prevention delivery. We quantified attainment of prevention indicators, sex- and age-related heterogeneity, and projected prevention gains. Methods: We analyzed 24,183 recurrent ischemic stroke admissions from 81 Korean Stroke Registry hospitals (2018-2023). Annual attainment of antithrombotic therapy, low-density lipoprotein cholesterol (LDL-C) <70 mg/dL, glycated hemoglobin (HbA1c) <7.0% in diabetes, non-current smoking, and normal weight (body mass index [BMI] 18.5-24.9 kg/m²) was age-standardized descriptively; temporal trends were assessed with hospital-clustered generalized estimating equation models. Projections combined observed implementation gaps with trial-derived relative risk reductions. Results: Antithrombotic use increased from 74.6% to 79.4% (odds ratio [OR]/year 1.05, 95% confidence interval 1.01-1.09), but plateaued after 2019, leaving 20.6% untreated in 2023. Among 4,441 patients with known atrial fibrillation (AF), oral anticoagulant use rose from 65.3% to 73.3% (OR/year 1.08; P=0.005), and 26.7% remained untreated. LDL-C <70 mg/dL improved from 32.6% to 41.9% (OR/year 1.08; P<0.001), whereas HbA1c, smoking, and weight indicators showed limited overall progress. Heterogeneity emerged: non-current smoking improved in men but not women (already near ceiling, approximately 95%); LDL-C control did not improve in adults aged 19-49 years; and BMI ≥25 kg/m² rose from 36.2% to 56.2% in this age group. Upper-bound projections estimated approximately 183, 126, and 201 potentially preventable recurrent strokes per year within the registry (not national estimates) from antithrombotic non-use, anticoagulant non-use in AF, and LDL-C gaps in large-artery atherosclerosis, respectively. Conclusions: Recurrent-stroke admission revealed persistent, unevenly distributed prevention gaps. Medication reconciliation, AF detection and anticoagulation, lipid intensification, and tailored behavioral pathways should be prioritized.
Source: Journal of Stroke
Authors: Eung-Joon Lee, Matthew Chung, Han-Yeong Jeong, Jayoun Kim, Nan Hee Park, Min Kyoung Kang, Dongwhane Lee, Jinkwon Kim, Yo Han Jung, Sungwook Yu, Wook-Joo Kim, Han-Jin Cho, Kyungbok Lee, Tai Hwan Park, Mi Sun Oh, Ji Sung Lee, Joon-Tae Kim, Byung-Woo Yoon, Jong-Moo Park, Hee-Joon Bae, Keun-Hwa Jung
Institutions: Seoul National University, Seoul National University Hospital, SNUH SMG-SNU Boramae Medical Center, Chonnam National University, Yonsei University, Chonnam National University Hospital, Yongin Severance Hospital, Eulji University Uijeongbu Eulji Medical Center, Gangnam Severance Hospital, Korea University Anam Hospital, University of Ulsan, Pusan National University Hospital, Pusan National University, Soonchunhyang University, Soonchunhyang University Hospital Seoul, Seoul Medical Center, Hallym University Sacred Heart Hospital, Asan Medical Center, National Medical Center, Seoul National University Bundang Hospital
Language: English
Subfield: Clinical Neurology
Field: Medicine
Domain: Health Sciences
Open Access status: diamond
OpenAlex ID: W7220743056