Fleet and colleagues report that >85% of survivors of ischemic stroke, with hospital stays <30 days, most of whom were discharged back to the community, saw a family physician within 90 days of discharge and took lipid-lowering and antihypertensive medications (in those aged 65 years and older). These three metrics were the only metrics among all the studied metrics of secondary stroke preventive care that met the 85% threshold, a frequently used cutoff to evaluate the quality of care at a population level.^{Reference Arling, Reeves and Ross1,Reference Bravata, Myers and Arling2} Other metrics of care such as getting laboratory assessments for evaluation and control of LDL or HbA1c or seeing a specialist were closer to 60%. They found that the quality of stroke preventive care did not vary based on whether someone was admitted to a long-term care home after stroke or returned to the community or based on whether they survived 1 year or 3 years after the stroke.

While this study takes the first step in describing the state of secondary stroke preventive care in Canada, it did not uncover the reasons why some secondary stroke preventive care metrics are not met. A more systematic approach, guided by established frameworks such as the Chronic Care Model,^{Reference Wagner3} could provide valuable insights into gaps in care by addressing the interplay of health system design, community resources and individual factors. Mixed-methods approaches could evaluate variation across different social and structural determinants of health using quantitative data on adherence rates with qualitative insights into the lived experiences of patients, caregivers and providers.^{Reference Creswell and Cizek4} These methods would offer a nuanced understanding of how interpersonal, structural and systemic factors hinder secondary stroke prevention. By leveraging these insights, future interventions can be better tailored to empower all stakeholders involved, ultimately improving adherence to guidelines and achieving better outcomes. The study also highlights the need to develop standardized secondary stroke preventive care metrics that allow for comparison across jurisdictions and help quality improvement initiatives such as Get With the Guidelines or others⁵ to track and eventually improve these over time.

Some unanswered questions remain: What is the risk reduction of stroke or cardiovascular disease recurrence by receiving the guideline-recommended secondary stroke preventive care? Are some metrics more important than others when preventing stroke or cardiovascular disease recurrence? Answers to these questions may be the missing piece of the puzzle that helps motivate patients, caregivers, physicians and policymakers to improve secondary stroke preventive care.