Prevention

Definitions of Prevention

Primary prevention is an individually based clinical approach to disease prevention, directed toward preventing the initial occurrence of a disorder in otherwise healthy individuals.^76,77 Primary prevention is usually implemented in the primary care setting, and the physician, advanced practice nurse or patient may initiate a discussion of stroke risk reduction. Primary prevention and health promotion recommendations related to stroke (lifestyle and risk factor management, hypertension screening, dyslipidemia screening, diabetes management, management of atrial fibrillation, and asymptomatic carotid stenosis) emphasize the importance of screening and monitoring those patients at high risk of a first stroke event.

Primary prevention and the reduction of risk factor prevalence in the general population are not main purposes of the Canadian Best Practice Recommendations for Stroke Care; therefore, only selected recommendations related to primary prevention are included. A comprehensive set of recommendations in this area is being developed for inclusion in future updates.

Secondary prevention is an individually based clinical approach aimed at reducing the risk of a recurrent vascular events in individuals who have already experienced a stroke or transient ischemic attack and in those who have one or more of the medical conditions or risk factors that place them at high risk of stroke.⁷⁷Secondary prevention recommendations in this document are directed to those risk factors most relevant to stroke, including lifestyle (diet, sodium intake, exercise, weight, smoking, and alcohol intake), hypertension, dyslipidemia, previous stroke or transient ischemic attack, atrial fibrillation and stroke, and carotid stenosis. Secondary prevention recommendations can be addressed in a variety of settings—acute care, stroke prevention clinics, and community-based care settings. They pertain to patients initially seen in primary care, those who are treated in an emergency department and then released and those who are hospitalized because of stroke or transient ischemic attack.

Recommendations for secondary prevention of stroke should be implemented throughout the recovery phase, including during inpatient and outpatient rehabilitation, reintegration into the community and ongoing follow-up by primary care practitioners. Secondary prevention should be addressed at all appropriate healthcare encounters on an ongoing basis following a stroke or transient ischemic attack.

• Lifestyle And Risk Factor Management
• Blood Pressure Management
• Lipid Management
• Diabetes Management
• Antiplatelet Therapy
• Antithrombotic Therapy for Atrial Fibrillation
• Carotid Intervention