Secondary Prevention Gaps at Recurrent Ischemic Stroke Admission: A Nationwide Registry Study.
19 affiliations
- 1Department of Neurology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea.
- 2Institute of Public Health and Care, Seoul National University Hospital, Seoul, Korea.
- 3Department of Neurology, SMG-SNU Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea.
- 4Medical Research Collaborating Center, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea.
- 5Department of Neurology, Seoul Chuk Hospital, Seoul, Korea.
- 6Department of Neurology, Uijeongbu Eulji Medical Center, Uijeongbu, Korea.
- 7Department of Neurology, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin, Korea.
- 8Department of Neurology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
- 9Department of Neurology, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea.
- 10Department of Neurology, University of Ulsan College of Medicine, Ulsan, Korea.
- 11Department of Neurology, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea.
- 12Department of Neurology, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Seoul, Korea.
- 13Department of Neurology, Seoul Medical Center, Seoul, Korea.
- 14Department of Neurology, Hallym University Sacred Heart Hospital, Anyang, Korea.
- 15Clinical Research Center, Asan Medical Center, Seoul, Korea.
- 16Department of Neurology, Chonnam National University Medical School, Chonnam National University Hospital, Gwangju, Korea.
- 17Department of Neurology, National Medical Center, Seoul, Korea.
- 18Department of Neurology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea.
- 19Department of Neurology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea. [email protected].
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.
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BibTeX
@article{lee2026secondary,
title = {{Secondary Prevention Gaps at Recurrent Ischemic Stroke Admission: A Nationwide Registry Study.}},
author = {Eung-Joon Lee and Matthew Chung and Han-Yeong Jeong and Jayoun Kim and Nan Hee Park and Min Kyoung Kang and Dongwhane Lee and Jinkwon Kim and Yo Han Jung and Sungwook Yu and Wook-Joo Kim and Han-Jin Cho and Kyungbok Lee and Tai Hwan Park and Mi Sun Oh and Ji Sung Lee and Joon-Tae Kim and Byung-Woo Yoon and Jong-Moo Park and Hee-Joon Bae and Keun-Hwa Jung},
journal = {Journal of stroke},
year = {2026},
month = sep,
doi = {10.5853/jos.2026.02761},
url = {https://europepmc.org/article/MED/42894453},
note = {CC BY-NC},
}
RIS
TY - JOUR
TI - Secondary Prevention Gaps at Recurrent Ischemic Stroke Admission: A Nationwide Registry Study.
AU - Eung-Joon Lee
AU - Matthew Chung
AU - Han-Yeong Jeong
AU - Jayoun Kim
AU - Nan Hee Park
AU - Min Kyoung Kang
AU - Dongwhane Lee
AU - Jinkwon Kim
AU - Yo Han Jung
AU - Sungwook Yu
AU - Wook-Joo Kim
AU - Han-Jin Cho
AU - Kyungbok Lee
AU - Tai Hwan Park
AU - Mi Sun Oh
AU - Ji Sung Lee
AU - Joon-Tae Kim
AU - Byung-Woo Yoon
AU - Jong-Moo Park
AU - Hee-Joon Bae
AU - Keun-Hwa Jung
PY - 2026
DA - 2026/09/30
JO - Journal of stroke
DO - 10.5853/jos.2026.02761
UR - https://europepmc.org/article/MED/42894453
AB - 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.
SN - 2287-6391
SN - 2287-6405
ER -