In a new scientific statement entitled “Primary Care of Adult Patients After Stroke”, the American Stroke Association (ASA)—a division of the American Heart Association (AHA)—has provided a roadmap for holistic, goal-directed and patient-centred primary care in the system for adult patients with stroke. The statement is published in the peer-reviewed journal Stroke.
“In this statement, we affirm in a new way the role of the primary care professional in caring for people with stroke,” said Walter N Kernan, chair of the statement writing group and a professor of medicine at Yale University School of Medicine (New Haven, USA). “The core functions of primary care as a specialty include diagnosis and management of acute symptoms; chronic disease management; and 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 healthcare providers.”
According to an ASA press release, primary care professionals provide essential, comprehensive and consistent care to patients after a stroke—a complex disease that about 800,000 American adults will experience for the first time each year, 10% of whom will die within 30 days. Most people will also seek guidance from their primary care team to reduce their high risk for recurrent stroke, prevent complications and optimise overall wellbeing.
The association adds that the first primary care appointment after a stroke should occur soon after discharge from the acute care or rehabilitation hospital, generally within one-to-three weeks, although 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 could exacerbate the high risk for stroke recurrence that marks the first three months after hospital discharge.
The ASA notes that its recent statement summarises the available literature of primary stroke care, and outlines the need for comprehensive post-stroke management that includes engaging caregivers and family members to support the patient. It also alludes to the fact that screening at the first appointment—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, the ASA statement concludes.