Longer term patient management following stroke: A systematic review

Notice that fuckingly lazy word; 'management', NOT RESULTS OR RECOVERY. This is why everything in stroke needs to be destroyed and rebuilt with survivors in charge.  Are you OK with such shit when you, your children or grandchildren have strokes?

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? I see nothing of the sort.) 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(Stroke survivors don't want 'care' you blithering idiots; they want 100% recovery. GET THERE!) 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.