How home blood pressure testing could reduce strokes

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Listen to Professor Jonathan Mant discuss ‘How home blood pressure testing could reduce strokes’ on a Naked Scientists podcast, recorded in 2018

Reference: McManus RJ, Mant J, Franssen M, Nickless A, Schwartz C, Hodgkinson J, Bradburn P, Farmer A, Grant S, Greenfield SM, Heneghan C, Jowett S, Martin U, Milner S, Monahan M, Mort S, Ogburn E, Perera-Salazar R, Shah SA, Yu LM, Tarassenko L, Hobbs FDR; TASMINH4 investigators. Efficacy of self-monitored blood pressure, with or without telemonitoring, for titration of antihypertensive medication (TASMINH4): an unmasked randomised controlled trial. Lancet. 2018 Feb 27. pii: S0140-6736(18)30309-X

My Life After Stroke – Complete

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34% of participants who attended a stroke review as part of our intervention attended at least one session of an MLAS course

28% of attendees brough a carer or significant other with them to at least one of the six sessions

73% of MLAS attendees completed an MLAS course based on the completion criteria

The majority of participants who completed an MLAS course had theistroke 10+ years ago

Professor Jonathan Mant summarises top tips for patients and practitioners on stroke risk assessment and reduction

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There are over 100,000 strokes in the UK per year. It is the fourth commonest cause of death, and is a leading cause of disability in the UK, with over 1.2 million survivors, costing the NHS and social care around £1.7 billion a year. Much can be done to reduce this burden of disease through prevention—the large INTERSTROKE case control study suggests that modifiable risk factors potentially account for 90% of all stroke cases.

  1. Eating a healthy diet
    Diet has a big impact on stroke risk. Changing diet can help a patient to reduce their risk of stroke in several different ways: reducing dietary sodium intake and increasing fruit and vegetable consumption will lower blood pressure, an important risk factor for stroke (see below) and a diet rich in fruit, vegetables, nuts, fish, and olive oil—the so-called ‘Mediterranean diet’—will reduce risk of stroke and myocardial infarction. Likewise, weight loss will reduce body mass index (BMI), which is in turn a risk factor for stroke (at least down to a BMI of 22.5)
  2. Adopt a healthy lifestyle
    As well as diet, changing other lifestyle habits can help to reduce stroke risk. Any physical activity compared to inactivity is associated with reduced risk of stroke. Smoking is associated with a 2–3-fold increase in risk of death from stroke. Stopping smoking, even at older ages, will have an effect on future stroke risk. Alcohol consumption is associated with increased stroke risk, with each 100g (i.e approximately 12 units) associated with a 14% increase in risk.
  3. Use a cardiovascular disease risk calculator to assess stroke risk
    Risk factors for stroke and coronary heart disease overlap, so for practical purposes, a cardiovascular disease risk calculator (rather than a stroke-specific risk calculator) is appropriate to identify high-risk individuals and inform treatment options. 
  4. Treat high blood pressure
    Hypertension is a major risk factor for stroke so it is important to treat high blood pressure.
  5. Statin therapy
    Statin therapy is effective at reducing risk of stroke, and should be offered to people depending upon their underlying cardiovascular risk. There is strong evidence from randomised controlled trials that use of statins lowers risk of stroke and other cardiovascular events and increases life expectancy.
  6. Take opportunities to case find atrial fibrillation
    Opportunistic case finding is an effective way to identify atrial fibrillation (AF), an important risk factor for stroke. Atrial fibrillation is associated with a nearly five-fold increase in risk of stroke. 
  7. Anticoagulation for people with AF
    Anticoagulation is highly effective at reducing the risk of stroke in people with AF. 
  8. Urgent specialist assessment after TIA
    The early risk of completed stroke after a transient ischaemic attack (TIA) is high—about 5% within a week—so urgent specialist assessment and treatment of possible TIAs is required. This risk can be modified by prompt secondary prevention treatment, particularly with aspirin, and further investigation may reveal underlying causes such as carotid stenosis or atrial fibrillation. The National clinical guideline for stroke recommends: ‘patients with acute neurological symptoms that resolve completely within 24 hours (i.e. suspected TIA) should be given aspirin 300 mg immediately and assessed urgently within 24 hours by a specialist physician in a neurovascular clinic or an acute stroke unit.’
  9. Antithrombotic therapy 
    Existing cardiovascular disease is an important risk factor for further cardiovascular events and the risk can be reduced by antiplatelet therapy. 
  10. Consider all secondary prevention options
    People who have had a stroke are at high risk of a second stroke so all secondary prevention options should be considered. 

To read the full article and reference list as published in the Guidelines in Practice journal please click here

*a full reference list can also be found here

Read our review exploring why stroke survivors and carers feel abandoned

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The article entitled: “Stroke survivors’ and informal caregivers’ experiences of primary care and community healthcare services – A systematic review and meta-ethnography” was recently published by PLOS ONE. The article was written by Dominika M PindusRicky Mullis, Lisa Lim, Ian WellwoodViona Rundel, Noorazah Abd Aziz,and Jonathan Mant

The study suggests that primary care and community health care interventions which focus on improving active follow-up and information provision to patients and caregivers, especially in the first year after stroke, could help improve patient self-management and increase stroke-specific health literacy.

You can find the full article published here.

Stroke survivors and caregivers feel abandoned by health services, study finds

IPCAS Pilot complete

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All enhanced stroke reviews and participant follow-up questionnaires for the IPCAS pilot study are now complete. A total of 13 stroke survivors were recruited from one GP practice in the East of England. Feedback from participants was positive and the IPCAS intervention was found to be acceptable to General Practice staff.

Further updates on study results and publications will be available on this website in the near future.

Ethical approval for the IPCAS Randomised Controlled Trial

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A favorable ethical opinion was given by the Yorkshire & The Humber, Bradford Leeds Research Ethics Committee for the IPCAS RCT on the 19th December 2017. The study will be called: “Improving Primary Care After Stroke (IPCAS): A randomised controlled trial to evaluate a new model of care for stroke survivors living in the community”. You can find out more about the study here.

MLAS Pilot complete

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All of the community based group sessions running as part of the “My Life After Stroke” pilot study have now been successfully completed. The feedback from participants has been extremely positive and we are excited to continue to develop this intervention. Further updates on study results and publications will be available on this website in the near future.

Chartered Society of Physiotherapy, variations in community stroke rehab.

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A press release published on 21 October 2016 by the Chartered Society of Physiotherapy discusses the inconsistencies in stroke care. This commentary focuses mainly on the need to address long term care and calls for investments in Early Supported Discharge services.

A protocol for a scoping review, accepted for publication by BMJ Open

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We are pleased to announce that the article entitled: “Primary care interventions and current service innovations in modifying long-term outcomes after stroke: a protocol for a scoping review” has now been accepted for publication by BMJ Open. The article was written by Dominika M Pindus, Lisa Lim, A Viona Rundel, Victoria Hobbs, Noorazah Abd Aziz, Ricky Mullis and Jonathan Mant.     read more…

Qualitative studies complete!

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The IPCAS team is excited to announce that all of our planned qualitative studies have now been completed. The interview and focus group transcripts will now be analysed and used to inform the development of the new model of primary care.