The feasibility of assessing prognosis over 3 years in persons with a previous stroke/transient ischemic attack in general practice

Background: Stroke has devastating consequences for survivors. Hypertension is the most important modifiable risk factor, and its management largely takes place in primary care. However, most stroke-based research does not occur in this setting. Ongoing hypertension and a risk of further stroke are a major concern for both patients and their general practitioners. We aim to assess whether it is feasible to assess prognosis in persons, with a previous stroke or transient ischemic attack (TIA), in general practice, and whether a well-powered observational study is possible. Methods: We performed a search of the electronic health record of individuals previously identified as having had a stroke or TIA, to assess prognosis over 3 years. Feasibility was assessed by meeting five criteria: (1) all general practices approached participated, (2) greater than 90% of patient records were accessible, (3) all study outcomes were available to review, (4) that collection data was less than 15 min per patient, and (5) a power calculation for a planned observational study could take place. Results: All six general practices approached participated freely, and 193/196 patients’ files were reidentified (98.5%). Twenty-eight cardiovascular events were recorded—most commonly a repeat TIA or ischemic stroke. Data collection took on average 5.5 min per file, and a power calculation for a planned observational study was completed. Conclusion: This study demonstrates that the proposed methodology for a full cohort study within general practice of patients post-stroke/TIA is both acceptable to practices and feasible. An adequately powered, “time-to-event” study is possible.