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Prevention Of Stroke

5th Edition
2014 UPDATED - December 2014

Secondary Prevention of Stroke Module Overview

Working Together with Stroke Survivors and their Caregivers to Achieve Optimal Outcome, the theme of the 2014 Canadian Stroke Best Practcies update,  is an imperative within secondary stroke prevention and applies across the system of care, with the participation of individuals with stroke, their families and caregivers, healthcare providers, and the broader community.  The primary underpinnings of ‘prevention’ require individuals with stroke  and healthcare team members to work together to identify risk factors and stroke etiology, agree on goals for prevention of recurrent stroke, and implement appropriate management strategies.

Achieving optimal outcomes for stroke survivors requires rapid access to specialized stroke prevention services; promotion of healthy lifestyles to minimize vascular risk; aggressive risk factor management, especially for blood pressure; appropriate prescription of medications for prevention; compliance with medication regimes and lifestyle changes such as diet, physical activity and smoking cessation; timely access to interventions such as carotid revascularization; and, screening of appropriate patients for smoking status, mood, cognition and obstructive sleep apnea.

Working Together in stroke prevention involves healthcare providers, policy makers, individuals with stroke, their families and caregivers, and the public.  A critical component of stroke prevention is access to specialized stroke prevention services, ideally provided by dedicated stroke prevention clinics.  Stroke prevention clinics (or similar vascular prevention clinics) provide a comprehensive interdisciplinary approach to prevention of first or recurrent stroke, conduct detailed assessments by a range of healthcare disciplines, facilitate timely access to appropriate diagnostics and interventions, and provide education to patients and families.  They also promote continuity of care between acute care facilities, the patient, their family and caregivers, and their primary care providers.

Recent reports on the quality of stroke services across Canada have shown that the number of prevention clinics has increased over the past five years (2008 to 2013); however, in some regions there is an insufficient number of stroke prevention clinics or similar services, even in urban areas where large volumes of stroke patients reside, and even fewer in rural settings.  Establishing stroke prevention clinics and services within all regions of care is an imperative in Working Together for stroke prevention.

Updates and Changes in Prevention of Stroke 2014 Update

The 2014 update of the Canadian Stroke Best Practice Recommendations Prevention of Stroke module reinforces the growing and changing body of research evidence available to guide stroke prevention services. A coordinated and organized approach to assessment and aggressive risk factor management is emphasized throughout this chapter.

Highlights of the moderate and significant updates as well as new additions to Prevention of Stroke module recommendations for 2014 include:

  • revisions to the recommendations for the assessment of risk of recurrent stroke and suggested urgency levels for investigations and initiation of management strategies;
  • continued emphasis on the important role of blood pressure for stroke, and diligent monitoring and treatment to keep blood pressure levels consistently lower than 140 mm Hg systolic and 90 mm Hg diastolic;
  • alignment of diabetes and stroke recommendations with updated guidelines by the Canadian Diabetes Association; revisions to the lipid management section to reflect ongoing analysis and interpretation of the SPARCL trial;
  • recommendations for prolonged heart rhythm monitoring for the detection of atrial fibrillation based on the findings of the EMBRACE and CRYSTAL AF trials;
  • anticoagulant therapy recommendations for patients with atrial fibrillation and stroke have been updated to include post-marketing research findings for the newer direct oral anticoagulants (DOACs), including the addition of the newer DOAC Edoxaban;
  • updates to the TAKING ACTION FOR STROKE PREVENTION QUICK response guide and pocket card.

Guideline Development Methodology:
The detailed methodology and explanations for each of these steps in the development and dissemination of the Canadian Stroke Best Practice Recommendations is available in the Canadian Stroke Best Practice Recommendations Overview and Methodology manual available on the Canadian stroke best practices website at http://www.strokebestpractices.ca/wp-content/uploads/2014/08/CSBPR2014_Overview_Methodology_ENG.pdf

Citing the Prevention of Stroke 2014 Module
Coutts S, Wein T, on behalf of the Prevention of Stroke Writing Group.  Prevention of Stroke Module 2014.  In Lindsay MP, Gubitz G, Bayley M, and Smith EE  (Editors) on behalf of the Canadian Stroke Best Practices and Advisory Committee.  Canadian Stroke Best Practice Recommendations, 2014; Ottawa, Ontario Canada: Heart and Stroke Foundation.

We invite comments, suggestions, and inquiries on the development and application of the Canadian Stroke Best Practice Recommendations.

Please forward comments to the Heart and Stroke Foundation’s Stroke Team at strokebestpractices@hsf.ca

Secondary Prevention of Stroke Module Contents: