AHA: Patients should visit PCP within 3 weeks of stroke to prevent recurrence
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The American Stroke Association, a division of the American Heart Association, has published a new scientific statement outlining the role of primary care providers in post-stroke care.
The association recommends that PCPs see their patients soon after they are discharged from the hospital for a stroke, usually within 1 to 3 weeks, to reduce the risk for recurrence. Currently, the average time to the first medical visit after hospital discharge is 27 days, according to Walter N. Kernan, MD, the chair of the statement writing group and a professor of medicine at Yale University School of Medicine, and colleagues.
“An early visit may reduce readmission and address inadvertent gaps in care that may exacerbate the high risk for stroke recurrence that marks the first 3 months after hospital discharge,” Kernan and colleagues wrote in the statement, published in Stroke.
About 800,000 adults in the United States will have a new stroke each year, and 10% of them will die within 30 days, the authors wrote. On average, in a primary care practice with 2,000 adult patients, 100 of them will have a history of stroke, and five to 10 will have a new stroke each year.
The statement, which is based on systematic literature reviews and professional guidelines, lists five general goals for PCPs: provide patient-centered care, prevent recurrent brain injuries, maximize function, prevent late complications and optimize patients’ quality of life.
In addition, the statement affirms that PCPs should screen patients with a history of stroke during every visit for new or chronic risks for recurrence, including high BP, high cholesterol, diabetes, atrial fibrillation and blockage in the carotid or other arteries. It also emphasizes the importance of screening patients for complications such as anxiety or depression, cognitive impairment, bone fracture, fall risk, osteoporosis, pressure ulcers and seizures.
“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,” Kernan said in a press release.
In a commentary, Deborah A. Levine, MD, MPH, an associate professor in the departments of internal medicine and neurology at the University of Michigan, said the statement is a “superlative document” that “summarizes the literature and guidelines into one easy-to-read, useable document for the busy primary care provider.”
“It provides clear, structured and actionable information for primary care providers to deliver high-quality care to individuals with stroke,” she wrote.
Still, Levine stressed the need for policy and system-level interventions to ensure patients with stroke have access to comprehensive care and to decrease the burden on individual PCPs. Although telehealth has expanded access to care for some patients, more efforts are needed, she said.
“We need to raise our voices and advocate to guarantee that all individuals with stroke have access to the high-quality care recommended in this outstanding article,” Levine wrote.
References:
American Heart Association. How to optimize the primary care of individuals with stroke. https://professional.heart.org/en/science-news/primary-care-of-adult-patients-after-stroke/commentary. Accessed July 15, 2021.
American Stroke Association. Comprehensive primary care is vital to holistic care and optimal recovery after a stroke. https://newsroom.heart.org/news/comprehensive-primary-care-is-vital-to-holistic-care-and-optimal-recovery-after-a-stroke. Accessed July 15, 2021.
Kernan WN, et al. Stroke. 2021;doi:10.1161/STR.0000000000000382.
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Ann Greiner
Primary care is essential to stroke prevention and stroke follow-up. We applaud the efforts of the American Heart Association and American Stroke Association to underscore the importance of primary care in managing this condition to achieve better population health outcomes and enhanced equity.
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