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After a Stroke

After a Stroke

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After a Stroke

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  1. After a Stroke www.bradfordvts.co.uk

  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. Bruce Davies

  3. PHCT Tasks • Information. • Support. • Secondary prevention. • Help with post stroke physical problems. • Treating depression. Bruce Davies

  4. Patient Questions • Patients and their carers need information after a stroke. • 80% survive a stroke. • 50% 10 year survival. 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. Bruce Davies

  6. Recurrence • 13% chance in the year after a stroke. • 5% per year thereafter. • 40% will eventually have a fatal MI. 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%. Bruce Davies

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

  9. Secondary Prevention • Hope trial- Ramipril. • Progress Trial - Perindopril. • 30% and 28 % respectively reduction in further vascular events with use of ACE. Bruce Davies

  10. Social Problems • Driving, and the DVLA. • Sex. • Work. • Problems of care and carers. Bruce Davies

  11. Common Physical Problems • Depression. • Emotional lability. • Convulsions. • Muscular pains – especially shoulder pain. • Thalamic syndrome. • Insomnia. Bruce Davies

  12. Common Physical Problems • Incontinence. • Leg swelling. • Contractures. • Falls. • All of these problems are amenable to treatment. Bruce Davies

  13. Carers • Need help. • Financial help. • Actual help. • Psychological help. • 12-25% of carers are depressed. • 14% give up work to care. 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. 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? Bruce Davies

  16. References • http://www.stroke.org.uk • http://www.rcplondon.ac.uk Bruce Davies