Secondary Prevention

 

Secondary stroke prevention is an individually based clinical approach to reducing the risk of 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. Secondary prevention recommendations 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 can be addressed in a variety of settings – acute care, stroke prevention clinics, and community-based care settings. Secondary prevention issues should be addressed at all appropriate health care encounters on an ongoing basis following a stroke or transient ischemic attack. 2

Best Practice Guidelines for Secondary Prevention of Stroke:

The Heart and Stroke Foundation of Ontario recommended Best Practice Guidelines for Stroke Care, 2003 are:

  1. Increase awareness of stroke warning signs and the appropriate actions to take
  2. Develop an optimal stroke prevention strategy in a timely manner for all individuals at high risk of stroke, all individuals with TIA, and all stroke survivors. The strategy should include the optimal use of stroke prevention services, a plan for lifestyle modification, pharmacotherapy, and a plan for effective communication between, client, primary care physician, and stroke prevention services
  3. Educate individuals at high risk of stroke, those who have experienced a TIA or stroke, family members, and health care providers about stroke prevention, relevant information resources, and how to gain access to them.

The 2008 Canadian Stroke Strategy Canadian Best Practice Recommendations for Stroke Care give detailed recommendations for secondary prevention of stroke. These can be viewed at: http://www.cmaj.ca/cgi/content/full/179/12/S1#FB21

Resources and Contacts:

The Ontario Stroke System has guidelines to support primary care practitioner in managing TIA’s and early symptoms of stroke (insert link to the secondary prevention page under development by HSFO). In addition, there are designated stroke centres with specialty clinics (insert link to the secondary prevention page under development by HSFO) for persons who have experienced a Transient Ischemic Attack.

Risk Stratification for Early Stroke Reoccurrence Following TIA

The Heart and Stroke Foundation has an excellent tool to help individuals identify their personal risk factors for stroke and how they can reduce personal risk. They can access this tool online at www.heartandstroke.ca and clicking on the risk assessment button or by phoning 1-888-473-4636. This same website and phone number can provide personalized help to reduce blood pressure.

September 2009: New from the Stroke Strategy!

“Is Your Blood Pressure on Target: Final Report.”

The idea of wearing Blood Pressure target buttons originated on the inpatient Stroke Rehabilitation Unit at Parkwood Hospital, St. Joseph’s Health Care London – an effort that resulted in increased awareness among staff, patients and families about blood pressure targets. Increasing awareness among these groups is a first step in achieving the outcomes of Ontario’s Chronic Disease Prevention and Management Framework: informed, activated individuals and families and prepared, proactive practice teams. The SWO Stroke Strategy wished to foster continued momentum for vascular prevention and hypertension management initiatives in the SW region. During a SWOSS regional workshop on hypertension in 2007, a task team of interested individuals established itself to broaden this initiative and pilot a “Blood Pressure button campaign” in a number of health care settings within the Southwestern Ontario Stroke Region. Read more in the final report.