STROKE: awareness of risk factors for stroke, quality of stroke care and outcomes after stroke

This thesis represents a series of papers that cover the spectrum of stroke prevention and treatment, from awareness of risk factors for stroke to the quality of acute stroke care for patients with stroke in Australia. The papers include data from a large-scale health promotion program, as well as from national hospital audits and a clinical quality registry. Each source of data has strengths and limitations. This body of work contributes new knowledge across this spectrum for one of the leading causes of global disease burden. The quality and importance of the research is highlighted by the fact that five of the papers were accepted in international journals with important standing in the field. The individual papers presented in this thesis have been published (or submitted to) high-profile, high-impact peer reviewed journals, which reinforces that these papers represent a significant body of work which individually and collectively have advanced knowledge in the area of stroke. Papers within this thesis have provided evidence that the health promotion initiative called the “Know your numbers” (KYN) Program, undertaken by the National Stroke Foundation (NSF), is a successful model for improving awareness of risk factors for stroke: - The KYN Program is a feasible and acceptable method of raising awareness of hypertension and diabetes in the Australian community. - The KYN Program can improve awareness of risk factors for hypertension and stroke among participants. - Participants in the KYN Program were effectively prompted to modify their cardiovascular risk. The KYN Program also provided evidence that: - one in two participants were at ‘high risk’ of developing diabetes - Non-invasive diabetes screening was an acceptable method for assessing risk of diabetes as part of opportunistic health checks in community pharmacies. Papers within this thesis have also provided evidence of how the quality of acute stroke care can influence outcomes for patients with stroke: - There are potential modifiable and non-modifiable factors associated with readmission after stroke. - Severe complications, which are potentially modifiable, were independently associated with readmission within 28 days of stroke. - Patients with transient ischaemic attack who had a large number of comorbidities and who present to emergency department multiple times before admission for stroke and were more likely to be readmitted within one year of stroke. - There are inequalities in the quality of care for Indigenous patients with stroke compared to non-Indigenous patients and, subsequently, poorer outcomes for Indigenous patients with stroke. The papers in this thesis have contributed to the aims of the World Stroke Organisation to foster the best standards of practice for patients with stroke and increasing stroke awareness among the Australian population.