The new scientific statement, "Primary Care of Adult Patients After Stroke," acknowledges the importance of primary care in the system of care for patients with stroke, summarizing the available literature and providing a roadmap for holistic, goal-directed and patient-centered care.
The statement is published today in Stroke, a journal of the American Stroke Association, a division of the American Heart Association.
Primary care professionals provide essential comprehensive and consistent care to patients after a stroke. Most people will seek guidance from their primary care team to reduce their high risk for recurrent stroke, prevent complications and optimize overall well-being. It outlines the need for comprehensive post-stroke management that includes engaging caregivers and family members to support the patient.
Stroke is a complex disease with many causes, consequences and treatments. According to the statement, approximately 800,000 U.S. 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 younger than 55 years of age and 40% over 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 over age 65 years. There are about 7 million adults in the U.S. living with stroke.
The first primary care appointment after a stroke should occur soon after discharge from the acute care or rehabilitation hospital, generally within 1-3 weeks. The current average interval to first medical visit for patients discharged home after stroke is 27 days. An earlier post-stroke visit may reduce hospital readmission and address inadvertent gaps in care that may exacerbate the high risk for stroke recurrence that marks the first three months after hospital discharge.
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.
Additional screening is also important for complications including anxiety or depression, cognitive impairment, bone fracture and fall risk, osteoporosis, pressure ulcers and post-stroke seizures.
Specialist referrals should be recommended for any of these complications as appropriate.
In this statement, we affirm in a new way the role of the primary care professional in caring for people with stroke. The core functions of primary care as a specialty include: 1) diagnosis and management of acute symptoms, 2) chronic disease management and 3) disease prevention. 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."
Walter N. Kernan, M.D., chair of the statement writing group and professor of medicine at Yale University School of Medicine, in New Haven, Conn
Kernan, W.N., et al. (2021) Primary Care of Adult Patients After Stroke: A Scientific Statement From the American Heart Association/American Stroke Association. Stroke. doi.org/10.1161/STR.0000000000000382.