2. After a Stroke

3. 15/8/01Bruce Davies2 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.

4. 15/8/01Bruce Davies3 PHCT Tasks Information. Support. Secondary prevention. Help with post stroke physical problems. Treating depression.

5. 15/8/01Bruce Davies4 Patient Questions Patients and their carers need information after a stroke. 80% survive a stroke. 50% 10 year survival.

6. 15/8/01Bruce Davies5 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.

7. 15/8/01Bruce Davies6 Recurrence 13% chance in the year after a stroke. 5% per year thereafter. 40% will eventually have a fatal MI.

8. 15/8/01Bruce Davies7 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%.

9. 15/8/01Bruce Davies8 Secondary Prevention Target BP 140/85mmHg or 130/80 if concurrent diabetes. Lifestyle advice. Anti-platelet drugs. Anti-coagulation if appropriate.

10. 15/8/01Bruce Davies9 Secondary Prevention Hope trial- Ramipril. Progress Trial - Perindopril. 30% and 28 % respectively reduction in further vascular events with use of ACE.

11. 15/8/01Bruce Davies10 Social Problems Driving, and the DVLA. Sex. Work. Problems of care and carers.

12. 15/8/01Bruce Davies11 Common Physical Problems Depression. Emotional lability. Convulsions. Muscular pains – especially shoulder pain. Thalamic syndrome. Insomnia.

13. 15/8/01Bruce Davies12 Common Physical Problems Incontinence. Leg swelling. Contractures. Falls. All of these problems are amenable to treatment.

14. 15/8/01Bruce Davies13 Carers Need help. Financial help. Actual help. Psychological help. 12-25% of carers are depressed. 14% give up work to care.

15. 15/8/01Bruce Davies14 Conclusion A general practioners real job starts after they leave hospital and goes on for years. An area for planned on-going care.

16. 15/8/01Bruce Davies15 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?

17. 15/8/01Bruce Davies16 References http://www.stroke.o rg.uk http://www.rcplondo n.ac.uk