After a Stroke

1
After a Stroke

• www.bradfordvts.co.uk

2
Some Numbers

• Each GP will have 4 new strokes a year to deal
  with.
• Each GP will have about 15 patients with old
  strokes on their list.
• A quarter of severely disabled people in the
  community are stroke patients.

3
PHCT Tasks

• Information.
• Support.
• Secondary prevention.
• Help with post stroke physical problems.
• Treating depression.

4
Patient Questions

• Patients and their carers need information after
  a stroke.
• 80 survive a stroke.
• 50 10 year survival.

5
Disability Figures

• 25 entirely dependant on a carer.
• Another 30 need help with ADL.
• lt50 are fully independent.
• 25 become depressed.
• At 6 months 70 can walk independently but only
  20 at pre stroke speed.

6
Recurrence

• 13 chance in the year after a stroke.
• 5 per year thereafter.
• 40 will eventually have a fatal MI.

7
Secondary Prevention

• To reduce atherosclerotic risk.
• Based on RCP guidelines.
• Reduce cholesterol to less than 5mmol (40 die of
  an MI).
• Reduce BP, if it persists after 4 weeks post
  stroke. Each 5mmHg lowering of diastolic pressure
  reduces risk by 28.

8
Secondary Prevention

• Target BP 140/85mmHg or 130/80 if concurrent
  diabetes.
• Lifestyle advice.
• Anti-platelet drugs.
• Anti-coagulation if appropriate.

9
Secondary Prevention

• Hope trial- Ramipril.
• Progress Trial - Perindopril.
• 30 and 28 respectively reduction in further
  vascular events with use of ACE.

10
Social Problems

• Driving, and the DVLA.
• Sex.
• Work.
• Problems of care and carers.

11
Common Physical Problems

• Depression.
• Emotional lability.
• Convulsions.
• Muscular pains especially shoulder pain.
• Thalamic syndrome.
• Insomnia.

12
Common Physical Problems

• Incontinence.
• Leg swelling.
• Contractures.
• Falls.
• All of these problems are amenable to treatment.

13
Carers

• Need help.
• Financial help.
• Actual help.
• Psychological help.
• 12-25 of carers are depressed.
• 14 give up work to care.

14
Conclusion

• A general practioners real job starts after they
  leave hospital and goes on for years.
• An area for planned on-going care.

15
Audit?

• How many on anti-platelet drugs?
• How many had BP in last year?
• Cholesterol on target?
• Records of functional disability?
• Visits from PHCT?
• Carers identifiable?
• Services for carers?

16
References

• http//www.stroke.org.uk
• http//www.rcplondon.ac.uk