New guidelines for the treatment of patients with stroke and TIA

New guidelines launched today aim to help primary care teams deliver effective treatment and secondary prevention to stroke patients.

The Primary Care Concise Guidelines, developed by the Action for Stroke Group (ASG) in collaboration with the Royal College of Physicians (RCP), are based on the updated National Clinical Guidelines for Stroke published in July. The guidelines emphasise the importance of more active intervention to prevent and treat strokes.

For the first time, the guidelines cover the investigation and management of patients with a Transient Ischaemic Attack (TIA), who have a high risk of stroke within the first 72 hours of TIA, and as high as 20% within the first month. Acute stroke management is also covered, including the importance of brain imaging and admission to a specialist stroke unit. The section on longer term management sets out best practice in reviewing and assessing patients, together with their information and support needs.

As much of the responsibility for delivering effective secondary prevention and managing longer term problems associated with stroke falls to the primary care team, the most up-to-date, evidence-based guidelines must be readily available for both short-term and long-term management of patients. The guidelines are condensed onto a handy, practical A4 card which can be kept on a GP’s desk or elsewhere in the practice for easy referral.

Professor Godfrey Fowler, chairman of the ASG and Emeritus Professor of General Practice at Oxford University said:

“I am delighted that that the RCP has collaborated with the ASG to produce a document to help primary care healthcare professionals manage their stroke/TIA patients. These patients are at very high risk of further vascular events and it is important that they receive optimal therapy and management.”

Dr Tony Rudd, St Thomas’s Hospital, London and Stroke Associate Director, RCP said:

“In the second edition of the National Clinical Guidelines for Stroke we included more information for primary care. The ASG’s idea to condense this information onto an A4 card so that primary care has an “at a glance” reference document was excellent. I am delighted that together we have made this vision a reality.”

Stroke is the fourth largest cause of death in the UK. Twice as many people in the UK die from stroke as from lung cancer. More than three times as many women in the UK die from stroke as from breast cancer.

The improvement of the management of stroke is key to the government’s agenda of improving the health of the nation. Professor Ian Philp, Professor of Health Care of Elderly People and National Director for Older People's Services commented: “The guidelines are soundly evidence-based and professionally supported. I regard them as a gold standard to which we should aspire and a stimulus for the professions to build on the progress in improving stroke services which we have led through national policy.”

Jon Barrick, Chief Executive of The Stroke Association, said:

“Over 130,000 people have a stroke each year, and it is a leading cause of adult disability. Stroke is often a long-term condition and requires and deserves a fully integrated service that covers all aspects of treatment, rehabilitation and prevention in hospital and community based settings. The Stroke Association will continue working to ensure that this aim remains high on the government agenda. The primary care guidelines are an excellent aid that will help to ensure consistent treatment, care, rehabilitation and support for stroke patients, their families and carers in the community.”

The concise guidelines were peer reviewed by over 20 independent GPs who provided very positive feedback and are also endorsed by the Primary Care Cardiology Society (PCCS). Dr Nigel Tong, a GP from Liverpool, said: “It is great to see clear concise guidelines limited to two pages of A4. I think there’s every chance that GPs will keep a copy in their bag or desk.” and Dr George Kassianos, a GP from Bracknell and Fellow of the Royal College of General Practitioners commented: “This document will serve as a guidance to help unify stroke care throughout the UK and ensure that patients who present with a TIA receive prompt and accurate management.”

Laminated copies of the Primary Care Concise Guidelines for Stroke 2004 can be requested via email or post from [email protected] or PO Box 50331, London W4 1YS, respectively.