Longer term patient management following stroke: A systematic review

You're completely missing the elephant in the room. Long term patient 100% recovery is a disastrous 10% and nothing you even talk about here is going to change that. All because you have NO STRATEGY AND NO LEADERSHIP THAT IS TRYING FOR 100% RECOVERY.

Longer term patient management following stroke: A systematic review

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Christian Boehme, Thomas Toell, Wilfried Lang, ...

First Published May 20, 2021 Review Article Find in PubMed 

https://doi.org/10.1177/17474930211016963

Article information

Abstract

Background

Tremendous progress in acute stroke therapy(Really? tPA has only a 12% full recovery rate.) has improved short-term outcome but part of this achievement may be lost in the long run. Concepts for a better long-term management of stroke survivors are needed to address their unmet needs and to reduce the burden of post-stroke complications, residual deficits, and recurrent vascular events.

Aims

This review summarizes current knowledge on post-hospital care and the scientific evidence supporting individual programs.

Summary of review

A systematic search of electronic databases according to PRISMA guidelines identified 10,374 articles, 77 of which met the inclusion criteria. One large randomised controlled trial on a multifaceted care program delivered by the multidisciplinary stroke team reduced recurrent vascular events and improved quality of life and functional outcome one year after the event, while a number of studies offer solutions for individual components of post-hospital disease management like patient education, counselling, and self-management or the management of post-stroke complications and residual deficits. A majority of studies, however, was small in size and limited by a short follow-up. Most initiatives with a narrow focus on risk factor control failed to lower the risk of recurrent events. The caregivers’ central role in post-stroke patient management is broadly neglected in research.

Conclusions

Over the past years, first knowledge on how to best organize post-hospital care of stroke patients has emerged. Comprehensive and pragmatic programs operated by the multidisciplinary stroke team hold promise to reduce the long-term health burden of stroke. There is a clear need for further high-quality studies with both clinical endpoints and patient-reported outcomes to establish sustainable solutions in different settings and regions to improve life after stroke, a key priority of the Stroke Action Plan for Europe 2018–2030.

Keywords Stroke, post-stroke care, disease management, complication, follow-up, review

Background

Structured follow-up programs are a well-established standard of care for myocardial infarction and cancer but so far not for stroke.^1,2 In coronary and cancer patients, there is compelling evidence that standardized disease pathways positively affect risk factor profiles, quality of life (QoL), and functional status,^1,2 whereas high-quality studies testing follow-up programs for stroke patients have not been available until recently.

Stroke is a leading cause of death and disability globally. The current lifetime risk of stroke is 25% for both men and women.³ There are 14 million new strokes each year and over 80 million stroke survivors with a strong upwards trajectory given the continuous ageing of societies, population growth, and declining stroke fatality.⁴ Exciting recent advances in acute stroke therapy translate into improved short-term outcome⁵ which, however, may be lost in the long run through unmet needs in post-stroke care, post-stroke complications, residual deficits, and recurrent vascular events. Stroke is considered preventable by guideline-compliant control of risk factors and adequate vascular prevention may also be effective in preserving cognitive abilities. However, there is a significant gap between recommended preventive measures and real-world target level achievement of risk factors, especially in secondary stroke prevention.⁶

Concepts for a better long-term management of stroke patients are urgently needed and the Stroke Action Plan for Europe 2018–2030 has declared life after stroke a key priority.⁷ We herein report a systematic review of randomised controlled trials and rigorous scientific evaluations of structured multimodal intervention programs targeting longer term care of stroke patients.

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