BACKGROUND

Stroke is the second leading cause of death and the leading cause of disability in the Philippines. Despite the availability of clinical practice guidelines, there exist variation in the management pattern among neurologists.

OBJECTIVE

To determine the current practice patterns of Filipino adult neurologists caring for stroke patients and their conformity with the current clinical guidelines of the Stroke Society of the Philippines (SSP). Results are compared to a previous similar survey done in 2002 to determine changes in practice trends.

METHODOLOGY

Cross-sectional survey using a 3 page, 23-item questionnaire reviewed by the Stroke Council of the Philippine Neurological Asssociation (PNA).

RESULTS

From November 2007 to October 2008, 1 76 of 217 1ocally practicing board-certified adult neurologists of the Philippine Neurological Association (PNA) answered the survey achieving an 81.1% response rate. The following were the important findings: 1) 76.9% underestimated the benefit of warfarin for nonvalvular atrial fibrillation (NVAF); 2) despite the average 22 stroke patients seen in a week, 67% have used oral anticoagulation to no more than 8 patients during the past 6 months; 3) the two most important reasons provided for not giving oral anticoagulation were uncertainty of good follow-up from the patient and fear of bleeding complications; 4) for acute infarcts, although the recommended systolic blood pressure (SBP) threshold is ≥220mmHg, 65.3% would start antihypertensive treatment at 1 80mmHg; 5) ) for acute primary intracerebral hemorrhage (ICH), although SBP threshold is >180 mmHG, 89.6% would start antihypertensive treatment at 1 60mmHg; 6) despite the absence of guidelines recommending neuroprotective drugs for acute stroke, 75.6% and 48.0% prescribed it to >80% of their patients with infarcts and ICH respectively; 7) 54.3% have not experienced giving thrombolytic therapy to any of their patients with acute ischemic stroke; 8) among patients with clinically stable hemorrhagic strokes, 81 .4% of the neurologists would start antithrombotics and 35% of them would start it at 30 days after the onset of stroke; 9) among patients with ischemic stroke and atrial fibrillation who developed hemorrhagic transformation, 25.1% of respondents would start anticoagulation at 30 days post stroke; 1 0) length of neurology practice was significantly associated with the following variables (PCONCLUSIONS

The following practice patterns of Filipino neurologists in relation to the SSP guidelines are noted: underutilization of warfarin among patients with NVAF, preference to start pharmacologic control of BP below the recommended systolic levels especially in ischemic stroke, extensive use of neuroprotective agents and limited experience with thrombolytic use. Compared to the survey done in 2002, the general trends in stroke management remained unchanged though more in conformity to existing stroke guidelines.

Stroke ; Clinical Practice Variations ; Survey ; Atrial Fibrillation ; Neuprotection