In addition to a healthy lifestyle, authors of the guidelines say primary care visits and emergency room visits provide a major opportunity to intervene and reduce the risk of stroke. Emergency room physicians could identify people at risk, particularly patients with diabetes, asymptomatic high blood pressure, or atrial fibrillation, and make recommendations to help prevent a first-time stroke, they say.
“Stroke remains a major health care problem,” Larry B. Goldstein, MD, chairman of the statement writing committee and director of the Duke Stroke Center in Durham, N.C., and his colleagues write in Stroke: Journal of the American Heart Association. “Its human and economic toll is staggering.”
The guidelines, last updated in 2006, now focus heavily on primary prevention. For the first time, the guidelines address stroke as a continuum of related events rather than a single isolated episode. These related events can include ischemic stroke, which accounts for 87% of all strokes, non-ischemic stroke, and transient ischemic attack, which in many cases is considered a warning sign of a possible impending stroke.
In the United States, stroke death rates have declined by more than a third between 1999 and 2006; however, stroke remains the third leading cause of death after cardiovascular disease and cancer. The authors note that although stroke was once considered to be a condition of the elderly, the number of pediatric stroke cases has risen in recent years. More than 77% of the 795,000 strokes in the U.S. are first-time events; there are 6.4 million stroke survivors in the U.S. Twenty percent of stroke survivors are so functionally impaired that they require institutional care.