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[High time for cerebral rehabilitation following stroke: discrepancies between guidelines and practice]
Sander M van Schaik1, Renske M van den Berg-Vos, Henry C Weinstein
1Sint Lucas Andreas Ziekenhuis, afd. Neurologie, Amsterdam, the Netherlands. s.vanschaik@slaz.nl
Insights
Secondary stroke prevention strategies are effective but underused in routine care. Standardized post-stroke care, similar to cardiac rehabilitation, could improve patient outcomes and reduce recurrent events.
Area of Science:
- Neurology
- Cardiovascular Medicine
- Public Health
Background:
- Patients with transient ischemic attack (TIA) or ischemic stroke face high risks of recurrent cardiovascular events.
- Cardiac rehabilitation programs significantly reduce mortality in myocardial infarction patients.
- Secondary prevention strategies for stroke are evidence-based but inconsistently applied in clinical practice.
Purpose of the Study:
- To highlight the suboptimal implementation of secondary stroke prevention in routine care.
- To propose a standardized post-stroke care model inspired by cardiac rehabilitation.
- To enhance the effectiveness of secondary stroke prevention.
Main Methods:
- Review of existing evidence on secondary prevention for TIA and ischemic stroke.
- Comparison of stroke care with established cardiac rehabilitation programs.
- Analysis of potential benefits of standardized post-stroke care protocols.
Main Results:
- Evidence strongly supports secondary prevention strategies for TIA and stroke patients.
- Current secondary stroke prevention practices in routine care are suboptimal.
- Standardized care mirroring cardiac rehabilitation shows promise for improving adherence and outcomes.
Conclusions:
- Implementing standardized post-stroke care, akin to cardiac rehabilitation, is a promising strategy.
- Improved adherence to guidelines and lifestyle changes can be achieved through structured post-stroke care.
- This approach could significantly enhance secondary stroke prevention effectiveness and reduce recurrent events.
Abstract:
Cardiac rehabilitation programmes reduce mortality in patients following myocardial infarction. Patients with a history of transient ischaemic attack (TIA) or ischemic stroke have a high risk of recurrent stroke or other cardiovascular events, comparable with the risk that myocardial infarction patients show for recurrence. Evidence for the effectiveness of secondary prevention strategies following TIA and ischemic stroke is compelling. Despite this convincing evidence, secondary prevention in the routine practice of stroke care is suboptimal. Improving adherence to guidelines and cardiovascular lifestyle changes by standardized post-stroke care, mirroring practice in cardiac rehabilitation programmes, could be a promising method for increasing effectiveness of secondary stroke prevention.
