Preventing a second stroke: are you doing enough?

Stroke is a preventable illness. But still millions of people suffer from stroke each year. Much more, many cases of strokes are not the first time but the second, maybe even then third. Now, the question is, does having had a first stroke make the patient and his or her healthcare provider more aware of the risks, thus more ready to take preventive measures? Does “forewarned is forarmed” apply here?

Researchers at the Mount Sinai School of Medicine in New York City report that although many services to avert a second stroke are available, not many patients avail of them. In fact, only about 50 to 70% of these facilities are generally used.

According to lead author Dr. Joseph S. Ross

“Alarmingly high numbers of adults did not receive stroke prevention services. Most usage rates for prevention services were between 50 percent and 70 percent. That’s a lot of people not getting recommended care.”

The study participants included 11,862 adults at least18 years old who have had a stroke. 54% of the participants were women. The services offered for secondary prevention are as follows:

• reduction of vascular risk, which includes taking preventive medications such as aspirin, and doing regular exercise
• annual testing for cholesterol testing
• management of high blood pressure;
• management of diabetes
• prevention of infectious disease

The key findings of the study are:

31% of patients received outpatient rehabilitation services;

52% reported influenza vaccination and 53 percent received pneumococcal vaccination;

57% percent exercised regularly;

77% percent used aspirin regularly;

66% percent received counseling to quit smoking;

62% percent with high blood pressure received low-fat diet counseling;

91% percent with high blood pressure reported currently taking hypertensive medication; and

89% percent of those with diabetes reported having annual glycosylated hemoglobin measurements for diabetes management. This measures the amount of sugar attached to the hemoglobin in red blood cells and shows the average blood sugar for several months before and can help regulate diabetic behavior.

There were no disparities in secondary stroke care in relation to gender, ethnicity, age or geographic residence.

The reasons behind the suboptimal use of secondary preventive care among stroke victims are not very clear. However, there is clearly a need for health care providers to focus on improving care for all stroke patients regardless of age, race or gender to uplift the level of care, thereby avert a subsequent stroke.

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