After a Stroke

15/8/01 Bruce Davies 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.

15/8/01 Bruce Davies 3

PHCT Tasks

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

15/8/01 Bruce Davies 4

Patient Questions

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

15/8/01 Bruce Davies 5

Disability Figures

25% entirely dependant on a carer.Another 30% need help with ADL.<50% are fully independent.25% become depressed.At 6 months 70% can walk independently but only 20% at pre stroke speed.

15/8/01 Bruce Davies 6

Recurrence

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

15/8/01 Bruce Davies 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%.

15/8/01 Bruce Davies 8

Secondary Prevention

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

15/8/01 Bruce Davies 9

Secondary Prevention

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

15/8/01 Bruce Davies 10

Social Problems

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

15/8/01 Bruce Davies 11

Common Physical Problems

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

15/8/01 Bruce Davies 12

Common Physical Problems

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

15/8/01 Bruce Davies 13

Carers

Need help.Financial help.Actual help.Psychological help.

12-25% of carers are depressed.14% give up work to care.

15/8/01 Bruce Davies 14

Conclusion

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

15/8/01 Bruce Davies 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?

15/8/01 Bruce Davies 16

References

http://www.stroke.org.uk

http://www.rcplondon.ac.uk