Longer term patient management following stroke: A systematic review

Abstract

<b>Background</b> Tremendous progress in acute stroke therapy has improved short-term outcome but part of this achievement may be lost in the long run. Concepts for a better long-term management of stroke survivors are needed to address their unmet needs and to reduce the burden of post-stroke complications, residual deficits and recurrent vascular events. <b>Aims</b> This review summarizes current knowledge on post-hospital care and the scientific evidence supporting individual programs. <b>Summary of review</b> A systematic search of electronic databases according to PRISMA guidelines identified 10,374 articles, 77 of which met the inclusion criteria. One large randomised controlled trial on a multifaceted care program delivered by the multidisciplinary stroke team reduced recurrent vascular events and improved quality of life and functional outcome one year after the event while a number of studies offer solutions for individual components of post-hospital disease management like patient education, counselling, and self-management or the management of post-stroke complications and residual deficits. A majority of studies, however, was small in size and limited by a short follow-up. Most initiatives with a narrow focus on risk factor control failed to lower the risk of recurrent events. The caregivers’ central role in post-stroke patient management is broadly neglected in research. <b>Conclusions</b> Over the past years, first knowledge on how to best organize post-hospital care of stroke patients has emerged. Comprehensive and pragmatic programs operated by the multidisciplinary stroke team hold promise to reduce the long-term health burden of stroke. There is a clear need for further high-quality studies with both clinical endpoints and patient-reported outcomes to establish sustainable solutions in different settings and regions to improve life after stroke, a key priority of the Stroke Action Plan for Europe 2018-2030.

Integrated care for optimizing the management of stroke and associated heart disease: a position paper of the European Society of Cardiology Council on Stroke

“…Emerging evidence suggests that comprehensive pragmatic care pathways with continued post-hospital involvement of the multidisciplinary stroke team could reduce the longer-term health burden of stroke. 218 Further high-quality studies are needed to inform sustainable long-term care pathways for long-term improvement in clinical and patient-reported outcomes among stroke patients.…”

Reconstruction of pseudonymized patient-trajectories in Austria’s stroke cohort using medical record-linkage of in-patient routine documentation to establish a nation-wide acute stroke cohort of 102,107 pseudonymized patients between 2015 and 2019

“…54 Recently, knowledge on how to best organize post-hospital care of stroke patients has emerged. 55 Additionally, the presented methodology poses the opportunity to assess ratios of patients receiving the essential treatments of stroke, namely SU care as presented in the accompanied analysis 56 , systemic thrombolysis and mechanical thrombectomy. Furthermore, in-hospital casefatality can be assessed.…”

“…54 Recently, knowledge on how to best organize post-hospital care of stroke patients has emerged. 55…”

Schlaganfallpfad Tirol

“…Der europäische Aktionsplan Schlaganfall 2018–2030 empfiehlt die Etablierung umfassender Schlaganfallpfade in allen Regionen und Ländern Europas [ 15 ]. Neben dem Schlaganfallpfad Tirol mit der ambulanten Rehabilitation gibt es keine qualitätsgesicherten publizierten Schlaganfallnachsorgeprogramme mit multimodalen Komponenten, welche die gesamte Versorgungskette umfassen [ 16 ].

…”