Pathways and tools of Stroke PROTECT: a hospital-based recurrent stroke prevention program

Patients hospitalized with recent symptomatic cerebral ischemia are at high early risk for subsequent cerebrovascular events. This notwithstanding, an unacceptably high proportion of these patients do not receive prompt and appropriate treatment with evidence-based, guideline-recommended, vascular risk-reduction therapies when exposed to conventional care. Studies of ischemic stroke and transient ischemic attack patients reveal that treatment guidelines are often not followed or variably applied, thereby impeding improvements in care quality and clinical outcomes. A likely contributor to this evidence-practice chasm has been the unavailability to care providers of user-friendly, broadly applicable tools/algorithms that could facilitate ready and uniform implementation of proven therapies.The Stroke PROTECT (Preventing Recurrence Of Thromboembolic Events through Coordinated Treatment) program, was designed for inpatient, outpatient, and transitional care settings, and systematically implements evidence-based medication and behavioral secondary prevention measures following the occurrence of an ischemic stroke or transient ischemic attack. PROTECT program pathways and tools incorporate early recognition and prompt initiation of evidence-based, guideline-recommended care in eligible patients without contraindications. The program has been associated with significant increases in discharge treatment utilization, as well as better therapy adherence, target biomarker control and enhanced clinical outcomes in the postdischarge setting. By utilizing best-care practices, PROTECT aims to help practitioners caring for patients with established cerebrovascular disease, to improve the quality of in-hospital and postdischarge stroke care.