Introduction: Standard modifiable risk factors (SMuRFs) – atleast one of hypertension, hyperlipidaemia, diabetes mellitus or smoking, are strongly associated with stroke. Evidence is limited on the quality of acute care and outcomes post-stroke for patients without any of these risk factors (SMuRF-less). We aimed to compare acute care and in-hospital outcomes following stroke by SMuRF status.
Methods: Data collected in the 2017 and 2019 National Acute Stroke Services Audit were analysed. In-hospital outcomes (mortality, complications, length of stay, independence, discharge destination) and acute care processes (emergency department screening, imaging, stroke unit care, acute pharmacotherapy, discharge: medications, patient education, care plan) were assessed. Multivariable logistic regression models compared acute care and outcomes using SMuRF-less status, adjusting for patient and hospital characteristics and clustering by hospital.
Results: Among 8368 patients with stroke from 122 hospitals, 1,285 (15%) were SMuRF-less (median age 71 years, 42% female) and 6,717 (85%) had SMuRFs (median age 76 years, 44% female). Compared to SMuRF patients, SMuRF-less patients were more likely to experience atrial fibrillation in-hospital (odds ratio [OR] 1.42, 95% CI 1.07-1.89), receive antiplatelets (OR 1.21, 95% CI 1.02-1.43) and be independent on discharge (OR 1.51, 95% CI 1.29-1.76). Conversely, fewer SMuRF-less patients were discharged on anti-hypertensives (OR 0.18, 95% CI 0.15-0.23) or statins (OR 0.47, 95% CI 0.35-0.63).
Conclusion: Although in-hospital outcomes were largely similar between SMuRF and SMuRF-less patients, there were notable differences in medication prescriptions at discharge.
Relevance to clinical practice or patient experience: The consequence of these disparities in clinical care warrants further investigation.