|Title:||Does a ‘polypill’ have a role in secondary prevention of stroke in older people in the developed world?|
|Project Description:||The aim is to gather, via a GP database search, data on patients in Primary Care who are on the Stroke/TIA register, to inform the design of a randomised controlled trial (RCT) that will test the effectiveness and cost effectiveness of treatment with a Polypill (fixed dose of 3 antihypertensive agents and one cholesterol-lowering agent) compared with conventional care. The data from this study will also be of value in their own right, providing a current description of secondary prevention following stroke/TIA in primary care and an analysis of factors that are associated with differences in uptake, including patient and practice level factors.
Later objectives of the Polypill Secondary Prevention of Stroke Programme include investigating potential barriers to the use of a polypill, a randomised controlled trial, investigation into behavioural and psychological consequences to a polypill approach and a health economic evaluation.
|Background:||People who have had a stroke or a transient ischaemic attack (TIA) are at high long term risk of a further cerebrovascular event. This risk can be substantially reduced by pharmacological therapy using anti-platelet agents (or in some instances anticoagulants), statins, and blood pressure (BP) lowering agents. However, audits in primary care continue to demonstrate that while use of anti-platelet therapy is now high in this population, treatment with BP and cholesterol lowering agents remains sub-optimal. For example, our analysis of the QRESEARCH general practice database found that a third of people were on no anti-hypertensive therapy after a TIA, and that nearly a half were not on a statin. Uptake is particularly poor in older people. This is a major issue since the majority of people on stroke/TIA registers in the community are over the age of 75. Pragmatic strategies designed at improving uptake have proved unsuccessful.
Therefore, there is a role for innovative strategies to improve uptake of statins and BP lowering drugs in older people with cerebrovascular (CV) disease. One such strategy that has been highlighted by WHO is to use fixed dose combination therapy, taking forward the ‘polypill’ concept.
|Start date:||1st April 2012|
|End date:||1st March 2017|
|Contact person:||Professor Jonathan Mant|
|Contact Details:||Strangeways Research Laboratory
Telephone: (01223) 330325
|Further Information, References and Publications|