Overview, Methods and Knowledge Exchange
6th Edition 2016-2018 UPDATE
The Canadian Stroke Best Practice Recommendations (CSBPR) are intended to provide up-to-date evidence-based guidelines for the prevention and management of stroke, and to promote optimal recovery and reintegration for people who have experienced stroke (patients, families and informal caregivers). The CSBPR are under the leadership of the Heart and Stroke Foundation, Canada (HSF) and involves over 200 volunteers from across Canada and internationally who have stroke expertise or who have been affected by stroke.
The CSBPR provide a common set of guiding principles for stroke care delivery, and describes the infrastructure necessary at a system level, and the clinical protocols and processes that are needed to achieve and enhance integrated, high-quality, and efficient stroke services for all Canadians. Through the innovations embodied within the stroke best practices, these guidelines contribute to health system reform in Canada and internationally.
The target audience for these recommendations includes all healthcare providers from a range of health disciplines who are involved in the planning, delivery and monitoring of quality stroke care.
Heart & Stroke works closely with national and provincial stakeholders and partners to develop and implement a coordinated and integrated approach to stroke prevention, treatment, rehabilitation, and community reintegration in every province and territory in Canada. The goal of disseminating and implementing these recommendations is to promote and support evidence-based stroke care across Canada, increase capacity for stroke service delivery, reduce practice variations in the care of stroke patients, and to reduce the gap between current knowledge and clinical practice.
The Canadian Stroke Best Practice Recommendations are developed and presented within a continuous improvement model and are written for health system planners, funders, administrators, and healthcare professionals, all of whom have important roles in the optimization of stroke prevention and care and who are accountable for results. A strong stroke research literature base is drawn upon to guide the optimization of stroke prevention and care delivery. Several implementation tools are provided to facilitate uptake into practice and are used in combination with active professional development programs. By monitoring performance, the impact of adherence to best practices is assessed and results then used to direct ongoing improvement. Recent stroke quality monitoring activities have compelling results which continue to support the value of adopting evidence-based best practices in organizing and delivering stroke care in Canada.
The Canadian Stroke Best Practice Recommendations development and update process is guided by a core set of principles which are applied to all activities of the writing groups. These principles state that all recommendations included in the CSBPR must be:
- Supported by high quality evidence and/or strong consensus that they are essential drivers to delivering high-quality stroke care;
- integral to facilitating health system improvement;
- aligned with other stroke-related Canadian best practice recommendations, e.g., the management of hypertension, diabetes, and dyslipidemia to decrease ambiguity and contradictions for front-line clinicians;
- reflective, in their totality, of the full continuum of stroke care.
The methodology for updating the recommendations includes twelve distinct steps to ensure a thorough and rigorous process. The detailed methodology and 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.
Updates and Revisions:
The Canadian Stroke Best Practice Recommendations undergo a thorough formal review and update of each chapter every two to three years. The CSBPR were first introduced in 2006, and subsequently updated and expanded in 2008, 2010, 2012 and 2015. The 2016 – 2018 update cycle is in the final completion stages, and the 2019 – 21 cycle was launched in January 2019.
Since research evidence for stroke care delivery is very dynamic and evolving, a protocol has been established to address late-breaking evidence in a timely way. When new evidence is released that may have an impact on any recommendations contained within these guidelines, the appropriate writing group is contacted and the evidence is reviewed, and decisions made regarding its impact on current recommendations. Any proposed revisions proceed through the same rigorous review process that is followed for the full chapter reviews. The CSBPR team then releases an interim bulletin regarding any off-cycle revisions that have been approved. These bulletins are incorporated into subsequent updates as applicable.
The CSBPR are made possible through the leadership of Heart and Stroke in collaboration with the Canadian Stroke Consortium and an extensive list of volunteers on our advisory committee and writing groups. These volunteers include people who are recognized leaders in the field of stroke care delivery, epidemiology, guideline development, systems change, and people who have experienced a stroke first hand or as a caregiver to someone who has had a stroke. All members of the CSBPR advisory committee and writing groups are required to complete declarations of conflict of interest prior to participation.
Current members of the Canadian Stroke Best Practices and Quality Advisory Committee are available here.
Current members of the CSBPR writing groups are available here.
- The human cost of stroke is immeasurable.
- Every year, approximately 62,000 people with ischemic stroke, hemorrhagic stroke and transient ischemic attack (TIA) are treated in Canadian hospitals.
- It is estimated that for each symptomatic stroke, there are nine covert strokes that result in vascular cognitive impairment – that can range from subtle changes in cognitive function and processes to severe vascular dementia.
- Stroke and other cerebrovascular diseases are the third leading cause of death in Canada.
- Stroke is the leading cause of adult disability, with over 405,000 Canadians living with the effects of stroke.
- About 60% of stroke patients are left with some disability and more than 40% are left with moderate to severe disability that requires more intense rehabilitation and support in the community. In Canada, 19% of people with stroke accessed inpatient rehabilitation services in 2016 and 10% were admitted to long-term care.
- 1.9 million brain cells die every minute during a stroke.
- The annual cost of stroke is approximately $3.6 billion, taking into account both healthcare costs and lost economic output.
- Although there are many proven interventions for stroke prevention, treatment and rehabilitation, they are not widely or consistently applied.
- In Canada there are more than 10,000 children (0 – 18 years) living with stroke.
This theme stresses the importance of integration and coordination across the healthcare system to ensure timely and seamless care of stroke patients to optimize recovery and outcomes.
Involvement of individuals who have had a stroke, their families and caregivers, is paramount to collaborations and partnerships and emphasized a patient and family-centred approach to stroke care delivery.
Working with interprofessional stroke care team members, other vascular care groups, emergency medical services, community care providers, educators, researchers, health system funders, planners and managers, will strengthen our ability to reduce risk factor prevalence, incidence, morbidity, and mortality from stroke.
Individuals who experience a stroke often present with additional health conditions or issues, which increases the challenges and complexity of comprehensive stroke management. Partnerships and collaborations with healthcare providers from a range of specialties is imperative to ensure people with multimorbidities have optimal control of each condition, do not fall through the cracks, do not receive conflicting or contra-indicated treatments, and do receive support to navigate the healthcare system.
Partnerships and collaborations are also necessary to support stroke care in rural and remote settings where some basic stroke services may not be available. People experiencing a stroke in those regions may not have access to optimal treatment strategies, which may result in poorer outcomes.
This theme aligns with and supports the Heart and Stroke Foundation’s Promote Recovery mission priority and is included as part of each module for the 2016-2018 update of the Canadian Stroke Best Practice Recommendations.
Heart & Stroke leads professional education activities that target members of interdisciplinary healthcare teams and system leaders who care for people who experience a stroke. We provide learning opportunities that address stroke care delivery across the full continuum of care. Our core knowledge exchange activities include:
- Stroke Best Practices webinar series: regular webinars that focus on new updates to our recommendations and more deeply explore current evidence and practice on specific topics relevant to stroke. Presentations are delivered by experts to increase knowledge and support the implementation of stroke best practice recommendations. Webinars are recorded and archived. To access the list of upcoming webinars and archived recordings visit the SBP webinars page.
- Implementation resources – a range of quick reference resources, training programs and links to high quality knowledge exchange tools are available within each recommendation section and Heart & Stroke developed resources are available on the professional resources webpage. Resources to support people experiencing stroke and their families are available on the patient resources page.
- Canadian Stroke Congress –The Canadian Stroke Congress (CSC), co-hosted by the Heart and Stroke Foundation and the Canadian Stroke Consortium, is the premier stroke congress in Canada. The goals of the Canadian Stroke Congress are to provide a high-quality educational event that will increase capacity and capability for stroke care in Canada. Information regarding the Canadian stroke congress can be found on the events webpage.
- Clinical Update – The Heart & Stroke Clinical Update is a two-day learning event that enables participants to bring the latest clinical developments, guidelines and practical knowledge pertaining to the prevention, diagnosis, assessment and management of cardiovascular and cerebrovascular diseases to patient practice. Clinical update is designed for healthcare providers across the continuum of care who support and manage people with heart disease and conditions, stroke and vascular cognitive impairment within their practice, especially primary care health team members and community-based providers across all disciplines and specialty areas.