The American Heart Association and American Stroke Association have published a new scientific statement in the journal Stroke, titled Primary Care of Adult Patients After Stroke. The statement, which is based on systematic literature reviews and professional guidelines, acknowledged the essential role of primary care physicians in caring for patients after a stroke.
The statement also provides a roadmap for comprehensive poststroke management that includes engaging caregivers and family members to support the patient. In the slides below, find details on 6 key takeaways of interest to primary care physicians.
“Primary care professionals can ensure consistent and comprehensive care for the full needs of patients, including coordinating any additional care or services patients may need from community services providers or from subspecialty health care providers,” said Walter N. Kernan, MD, chair, statement writing group, professor of medicine, Yale University School of Medicine, in an AHA press release.
According to the statement, approximately 800 000 US adults will have a new stroke each year, and 10% will die within 30 days. At the time of their stroke, approximately 5% of patients aged <55 years and 40% of those aged >85 years have moderate disability. By 90 days after a stroke, new stroke-related disability of at least moderate severity develops in 10% of younger adults to 30% of adults aged over 65 years.
The AHA/ASA statement recommends that the first primary care appointment after a stroke should occur within 1-3 weeks after the patient is discharged from the acute care or rehabilitation hospital, compared to the current average interval of 27 days.
The statement lists 5 generally accepted goals for poststroke care in primary care: provide patient-centered care, prevent recurrent brain injury, maximize function, prevent late complications, and optimize quality of life.
Special priorities for the first poststroke visit include:
• Obtain and review hospital records
• Solicit the patient’s experience
• Classify the stroke pathogenesis
• Implement time-sensitive management if indicated
• Check if the patient is a candidate for dual antiplatelet therapy
• Identify and remediate precursors of the stroke
The statement recommends that screening at the first and all subsequent appointments should include assessing new or chronic risks for recurrent stroke, such as high blood pressure, high cholesterol, diabetes, atrial fibrillation, and blockage in the carotid or other arteries.