Cardiovascular care of patients with stroke and high risk of stroke: The need for interdisciplinary action: A consensus report from the European Society of Cardiology Cardiovascular Round Table

Abstract

Comprehensive stroke care is an interdisciplinary challenge. Close collaboration of cardiologists and stroke physicians is critical to ensure optimum utilisation of short-and long-term care and preventive measures in patients with stroke. Risk factor management is an important strategy that requires cardiologic involvement for primary and secondary stroke prevention. Treatment of stroke generally is led by stroke physicians, yet cardiologists need to be integrated care providers in stroke units to address all cardiovascular aspects of acute stroke care, including arrhythmia management, blood pressure control, elevated levels of cardiac troponins, valvular disease/endocarditis, and the general management of cardiovascular comorbidities. Despite substantial progress in stroke research and clinical care has been achieved, relevant gaps in clinical evidence remain and cause uncertainties in best practice for treatment and prevention of stroke. The Cardiovascular Round Table of the European Society of Cardiology together with the European Society of Cardiology Council on Stroke in cooperation with the European Stroke Organisation and partners from related scientific societies, regulatory authorities and industry conveyed a two-day workshop to discuss current and emerging concepts and apparent gaps in stroke care, including risk factor management, acute diagnostics, treatments and complications, and operational/logistic issues for health care systems and integrated networks. Joint initiatives of cardiologists and stroke physicians are needed in research and clinical care to target unresolved interdisciplinary problems and to promote the best possible outcomes for patients with stroke.

Primärprävention des Schlaganfalls

“…Patienten mit einem erhöhten Risiko für einen Schlaganfall haben auch ein Risiko für kardiovaskuläre Ereignisse und den vaskulären Tod. Daher gelten die Empfehlungen für die Schlaganfallprävention in den meisten Fällen auch für die Prävention von Myokardinfarkten (MI) und die Behandlung der peripheren arteriellen Verschlusskrankheit (PAD) [2].…”

The role of cardiologists on the stroke unit

“…In fact, a stroke may often be the first clinical event leading to the emergency room (ER) or hospital presentation with a previously undetected cardiac problem as the underlying cause of the acute event. Therefore, it is the consensus of the European Society of Cardiology (ESC) cardiovascular round table that cardiologist expertise needs to be integrated on stroke units to address all cardiovascular aspects of acute stroke care 2 as thorough cardiovascular diagnostic workup is recommended in almost all stroke patients. This may already be started immediately upon medical contact and in ER since the established aetiology of the stroke is vital for further therapy decisions.…”

Cardiovascular treatment and prevention of stroke: The problem of cross-disciplinary interaction

“…[3][4][5] This challenge necessitates longterm co-operation not only between cardiologists, but also with general practitioners, therapeutists, neurologists, stroke physicians, vascular surgeons and other specialists. 6,7 A multidimensional treatment-and-care approach across different specialisms remains key to improving outcomes. 8,9 This problem mandates a greater number of doctors and level of resource than cardiologists alone are able to provide in conventional medical practice.…”

“…In the recent report from the European Society of Cardiology (ESC) Cardiovascular Round Table the main aspects of cardiovascular care in patients after stroke and at high risk of stroke were analysed. 6 The consensus between experts from the ESC and the European Stroke Organisation and other related scientific societies underlined the need for interdisciplinary action in both treatment and prevention of stroke. This publication paid special attention to cardiovascular care during hospital admissions and essentially completed recommendations developed in the previous position paper from the ESC Council on stroke.…”

“…However, the benefits of specially trained neurologists should not be underestimated. 6,7,15 In addition, highly qualified therapeutists and internal medicine specialists in co-operation with cardiologists may also offer a valuable contribution to the care of these patients within the multidisciplinary group. Less clear in the in- and outpatient setting is the role of stroke physicians in the treatment of patients with cardiovascular diseases at high risk of (but without previous) stroke.…”