1. After a Stroke

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.
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3. PHCT Tasks Information. Support. Secondary prevention.
Help with post stroke physical problems.
Treating depression.
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4. Patient Questions
Patients and their carers need information after a stroke.
80% survive a stroke.
50% 10 year survival.
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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.
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Bruce Davies

6. Recurrence 13% chance in the year after a stroke.
5% per year thereafter.
40% will eventually have a fatal MI.
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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%.
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8. Secondary Prevention
Target BP 140/85mmHg or 130/80 if concurrent diabetes.
Lifestyle advice.
Anti-platelet drugs.
Anti-coagulation if appropriate.
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9. Secondary Prevention Hope trial- Ramipril.
Progress Trial - Perindopril.
30% and 28 % respectively reduction in further vascular events with use of ACE.
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10. Social Problems Driving, and the DVLA. Sex. Work.
Problems of care and carers.
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11. Common Physical Problems
Depression.
Emotional lability.
Convulsions.
Muscular pains – especially shoulder pain.
Thalamic syndrome.
Insomnia.
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12. Common Physical Problems
Incontinence.
Leg swelling.
Contractures.
Falls.
All of these problems are amenable to treatment.
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13. Carers Need help. 12-25% of carers are depressed.
Financial help.
Actual help.
Psychological help.
12-25% of carers are depressed.
14% give up work to care.
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14. Conclusion
A general practioners real job starts after they leave hospital and goes on for years.
An area for planned on-going care.
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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?
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16. References http://www.stroke.org.uk http://www.rcplondon.ac.uk 15/8/01
Bruce Davies