Abstract
Recurrent ischemic strokes are a cause of significant healthcare burdens globally. Patients with uncontrolled vascular risk factors are more likely to develop recurrent ischemic strokes. This study aims to compile information gained from current secondary prevention programs. A pre-defined literature search strategy was applied to PubMed, SCOPUS, CINAHL, and Google Scholar databases, and studies from 1997 to 2020 were evaluated for quality, study aims, and outcomes. The search produced 1175 articles (1092 after duplicates were removed) and titles were screened; 55 titles were retained for the full-text analysis. Of the remaining studies, 31 were retained for assessment, five demonstrated long-term effectiveness, eight demonstrated short-term effectiveness, and 18 demonstrated no effectiveness. The successful studies utilized a variety of different techniques in the categories of physical fitness, education, and adherence to care plans to reduce the risk of recurrent strokes. The lessons we learned from the current prevention programs included (1) offer tailored care for underserved groups, (2) control blood pressure, (3) provide opportunities for medication dosage titration, (4) establish the care plan prior to discharge, (5) invest in supervised exercise programs, (6) remove barriers to accessing care in low resource settings, and (7) improve the transition of care.
Highlights
Stroke is a global public health concern in both developed and developing nations, spanning multiple healthcare delivery systems [1]
The predefined search strategy was run in March of 2020 and produced 1175 articles and 11 articles were identified through cross-reference checking
31 were retained for discussion (Tables 1 and 2, Supplemental Table S2). Several studies in their pilot stages focused only on outlining methodology and assessing feasibility; effectiveness could not be determined at this time
Summary
Stroke is a global public health concern in both developed and developing nations, spanning multiple healthcare delivery systems [1]. While clinicians and scientists have been encouraged by a 36.2% global decrease in deaths due to stroke and an 11.3% decrease in age-standardized stroke incidence rates from 1990 to 2016 [4,5], there remains room for improvement in terms of preventing recurrent strokes, which continue to be a source of ongoing disability [1,6]. Finding a way to accurately establish the risk of having a recurrent ischemic stroke remains difficult [7] and makes it challenging to plan and evaluate the effect of secondary prevention efforts [8,9]. The purpose of this systematic review was to identify peer-reviewed recurrent ischemic stroke prevention programs and analyze them in an effort to better inform the development and implementation of future programs. This review characterized the methods employed by effective studies, compared to unsuccessful studies, to generate a set of recommendations that may help elucidate what elements future successful stroke prevention programs should incorporate
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