We have three new licensed anticoagulant agents–dabigatran, rivaroxaban and apixaban. Their use for stroke prevention in AF is discussed: primary care is central to their utilisation.
The new oral anticoagulants, and their use in stroke prevention
Recognising stroke and transient ischaemic attack – the role of primary care
Stroke is the third commonest cause of adult death and the leading cause of complex disability in the UK. This article will discuss the importance of the early recognition of stroke and transient ischaemic attack and the role of primary care staff in implementing national guidelines. Practical case study examples are included.
How can we avoid a stroke crisis?
A report from a multidisciplinary alliance has made a compelling case for a coordinated planin Europe to reduce the health, social and economic burdens of stroke related to atrialfibrillation (AF). The group comprises eminent cardiologists, neurologists, a healtheconomists, hospital pharmacists, a haematologist and representatives from patientorganisations.How Can We Avoid a Stroke Crisis? has been endorsed by 17 medical and patientorganisations, including the European Primary Care Cardiovascular Society. Its aim is tohighlight to European policy makers the need to achieve earlier diagnosis and bettermanagement of AF across Europe, with the ultimate goal of reducing the risk of stroke inpatients with AF. The key points summarised in the report are shown in table 1.
Current evidence for the management and early treatment of transient ischaemic attack
Transient ischaemic attack (TIA) is an important risk factor for stroke. Early recognition of symptoms and timely secondary prevention significantly reduce stroke risk. We review current evidence and guidelines for early management and treatment of TIA, including early antiplatelet therapy, specialist review, and recognition and treatment of other risk factors. The roles of carotid artery and brain imaging are also considered.
How to use the GRASP-AF tool to reduce stroke risk in patients
Atrial fibrillation and stroke: Optimising prevention and treatment
Uniquely, AF is an eminently preventable cause of stroke with a simple and highly effective treatment. AF is common and affects over 600,000 patients in England (1.2%). It is a major predisposing factor for stroke, and strokes caused by AF can be particularly severe and disabling. The annual risk of stroke is five to six times greater in AF patients, but […]
Management and early treatment of transient ischaemic attack (TIA)
The White Paper, Saving lives: our healthier nation (1999), set out a target to reduce the death rate from coronary heart disease and related illnesses such as stroke by 40% in the under-75s by 2010;1 recent trends indicate that this target will be met. Although the past forty years have seen a significant reduction in age-standardised stroke mortality rates, stroke still accounts for around 53,000 deaths each year in the UK, with more than 9,500 of these occurring in the under-75s.2 This article reviews how we might reduce the huge burden of stroke by improving the management of transient ischaemic attack (TIA).
Risk stratification for stroke in patients with non-valvular atrial fibrillation – can we improve decision-making for optimal treatment?
Antiplatelet (usually aspirin) and anticoagulant (usually warfarin) treatments are available to reduce the risk of stroke in patients with atrial fibrillation (AF) but both have potentially harmful adverse effects and warfarin can be time-consuming and expensive to monitor. Guidance exists for choosing between treatments but is often insufficiently detailed to support an informed choice about the risk and benefits. Prescribers and patients are often left with a choice between aspirin or warfarin, and aspirin – which is perceived to be safer and easy to use – is often chosen. This article explores the evidence for aspirin and warfarin in preventing stroke in patients with AF, and describes how we should change the way that decisions about treatment are made.
“Heredity sets limits, environment decides the exact position within these limits” – Edwin Carleton MacDowell, 1887-1973
This quotation, although made more than one hundred years ago, remains very true today. New evidence from the INTERSTROKE study, published recently in The Lancet, shows that ten risk factors – many associated with lifestyle – account for 90% of the risk of stroke.1 Analysis of data from 6,000 people, half suffering strokes and the other half matched controls, from 22 countries worldwide between March 2007 and April 2010, revealed these risk factors are: high blood pressure, smoking, waist-to-hip ratio (abdominal obesity), physical inactivity, diet, lipids, diabetes, alcohol intake, stress and depression, and heart disorders.
People living in deprived areas show three times the risk of stroke deaths
People living in deprived areas are around three times more likely to die from a stroke than those in the least deprived, according to a report from the Stroke Association and the British Heart Foundation, which shows that death rates from stroke vary with social and economic conditions.
The report, which is the first comprehensive collection of national statistics on the burden of stroke, confirms that the stroke mortality rate for men and women of working age (under 65) has fallen consistently since the late 1970s. However, it shows that the rate has fallen more quickly in adults of higher social classes, resulting in an increase in inequalities in stroke death rates. The data show that stroke mortality increases with deprivation for both men and women. For premature mortality, the rate in the most deprived 5% of the population in England and Wales is more than three and a half times higher for men, and over two and a half times higher for women, than for those in the least deprived sector.
The statistics also show that people from lower social economic backgrounds are more likely to have major risk factors of stroke, including cigarette smoking and obesity. Professor Peter Weissberg, Medical Director at the British Heart Foundation said: “The picture these data on stroke present strongly mirrors figures for heart disease, which is also much more common in deprived communities. Many of the risk factors for heart disease and stroke, such as smoking and high blood pressure, are the same and potentially modifiable. The statistics argue for a concerted effort to identify and modify risk factors, by lifestyle and drug interventions, in those communities with the highest risks.-
What is the evidence for statins in the secondary prevention of stroke?
The Stroke Association estimates that about 150,000 people suffer a stroke in the UK each year. Stroke is the third commonest cause of death in developed countries and the leading cause of disability. So can we reduce this burden? In this article, we look at the evidence for statins in the secondary prevention of stroke.
Transient ischaemic attack: the ‘funny do’ that is no joke
How do you recognise a transient ischaemic attack (TIA) and how does this differ from a full stroke? In this article, we explore the ABCD2 score, which can be used to identify high- and low-risk TIAs, and the best course of action if a TIA is suspected. A TIA is very often the herald of a more serious and permanent stroke, underlining why it should be acted on as a matter of urgency, and there is an update on the current guidance from NICE and the Royal College of Physicians.
