Observational study data have suggested that neurologists preferentially selected
younger patients with generally few traditional stroke risk factors for homocysteine
testing. The aim of this study was to corroborate observational data by assessing
neurologists’ reported practices for the detection and treatment of hyperhomocysteinemia
in patients with acute ischemic stroke. All academic neurology faculty (n = 49), trainees
(neurology residents/fellows, n = 53), and a random sample of community-based neurologists
(n = 66) throughout North Carolina were surveyed regarding their homocysteine testing
and treatment practices. Nine neurologists were ineligible because they had either
retired or moved out of state. A total of 93 of the remaining 159 surveys (58.5%)
were completed (response rates: faculty, 74%; trainees, 47%; community-based neurologists,
56%). Patients age < 50 years (n = 52; 63%) and the absence of traditional stroke
risk factors (n = 57; 70%) were the most common factors cited as prompting homocysteine
testing. The homocysteine level threshold for treatment varied independently by practice
type (faculty: median, 14 μmol/L; range, 6–16 μmol/L; trainees: median, 14.5 μmol/L;
range, 10–20 μmol/L; community-based: median, 10.4 μmol/L; range, 7–15 μmol/L; P = .01), the number of stroke patients evaluated during a typical week (Spearman’s
r = .32; P = .034), and year of training completion (Spearman’s r = .41; P = .003). About half (51%) treat elevated homocysteine with a combination of folate,
vitamin B12, and vitamin B6. Consistent with observational data, the majority of the neurologists surveyed report
that they select young stroke patients who lack traditional stroke risk factors for
homocysteine testing. Thresholds for treatment varied between community-based and
academic neurologists and correlated with the physicians’ stroke patient volume.
Key words
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Article info
Publication history
Accepted:
December 22,
2004
Received:
November 16,
2004
Footnotes
Supported by National Institutes of Health grant K23 NS41929.
Identification
DOI: https://doi.org/10.1016/j.jstrokecerebrovasdis.2005.01.003
Copyright
© 2005 National Stroke Association. Published by Elsevier Inc. All rights reserved.
