Saudi Stroke Standards

Secondary Prevention QM 5.3.1: Counselling for lifestyle modification Purpose Stroke is preventable and the best defense against recurrent stroke is to increase awareness about stroke prevention. Stroke survivors should be managed within a stroke program that focuses on managing stroke symptoms, reducing risk factors, and promoting healthy lifestyle to prevent recurrent stroke. Lifestyle modification that focuses on dietary modification, weight reduction and increased physical activity is essential for stroke occurrence prevention. Lifestyle modifications including daily physical activity and weight management are associated with risk reduction in stroke and cardiovascular diseases. Rationale  Incidence of stroke is rising rapidly in Saudi Arabia and local data, suggests that 23.3% of all strokes were recurrent ones.  The trend is significant; without increased prevention, the incidence of stroke will increase. The 10-year forecast for Riyadh region is 8,00 – 9,200 per year, similar increase in stroke prevalence is expected nationally (Unpublished data).  Adherence to medication and lifestyle regimen is a key for stroke prevention.  Studies show that 25% of stroke survivors stop taking one or more of  prescribed stroke prevention medications within the first three months.  Diet that has five serving vegetables and fruits per day may reduce the risk of stroke Standards 1. All patients should be counselled regarding the need for lifestyle modification. 2. All patients with stroke should have identified risk factors for stroke documented and communicated to the patients. 3. Each risk factor should be managed for effective control and prevention of recurrent stroke (a plan for managing each risk factor should be documented). 4. The patient must be actively engaged in the plan of stroke prevention. 5. Increased physical activity with a structured exercise program should be recommended for adult patients with stroke. 6. Technology should be incorporated into interventions and programs may offer novel opportunities to increase physical activity and improve health fitness. 7. Counselling for lifestyle modification should be considered for all stroke patients, this may include:  Receiving stroke education  Visits for nutritional specialist clinic  Follow up visits to specialist clinic  Referral to primary care physician  Set up target blood glucose level 140-180 mg/dL (Normoglycemia)  Assessment of smoking history in each follow up visit  Counselling for smoking cessation  Discharged on statin therapy  Number of follow up visits to lifestyle modification clinic. QM 5.3.2: Blood pressure management in patient with acute ischemic stroke Purpose Because of the high prevalence of hypertension among a patient with stroke and its association of increased risk of CHD, recurrent stroke, and end-stage renal disease, patients