Authors' objectives:

To summarise and critically analyse the current facts concerning the prevention, diagnosis, treatment and rehabilitation of stroke.

Authors' results and conclusions: Stroke is one of the most common causes of disability and death in Sweden with nearly 35,000 people affected each year. In Sweden, stroke generates 3-4 million bed days annually with an associated medical care cost of 10 billion SEK. Nearly 25% of all stroke patients die within weeks, and up to 40% die within one year. For now, the most important goal of the health service should be to ensure good and accessible nursing care for stroke patients. Patients that can benefit from treatment and rehabilitation should have access to these services. The measures which currently appear to be most effective are: early and well planned care and rehabilitation after onset of stroke; and, medical or surgical treatment of underlying conditions for patients with conditions involving a risk for stroke.

Authors' recommendations: The most important aim should be to prevent stroke. Controlled studies have demonstrated that some interventions, such as adequate treatment of high blood pressure, anticoagulation treatment, surgical treatment, acetylsalicylic acid treatment and intervention against smoking for appropriate patients under certain conditions can help prevent stroke. Clinics with stroke units should continue to provide care, but should be assessed. Stroke patients require immediate acute care including rapid and precise diagnosis, assessment of benefits from active rehabilitation, a documented plan of nursing, medical and rehabilitative care, participation of the family and the development of plans for continuous care if necessary. Many routines currently used to treat stroke patients should be discontinued including determining blood cholesterol values, coagulation variables, and extensive heart studies, unless otherwise indicated. The need for angiography prior to carotid artery surgery should be reassessed. Many drug therapies, such as steroid treatment and infusions for blood viscosity, have no effect on stroke and/or are contraindicated. A plan should be developed to address how diagnosis and surgery of stenosis in the carotid artery should be delivered in Sweden. Cardiovascular research and research in the neurosciences directed towards underlying causes of stroke should be promoted. Current and proposed research on care for stroke patients should be monitored internationally. It is important to initiate scientific studies which assess the effect of physical therapy, occupational therapy, speech therapy, nursing and organisation of care for stroke patients. Different organisational approaches for care of stroke patients should be assessed. Other output or dissemination activity: SBU has made a follow-up study of the report in patients treated in 9 hospitals in the north of Sweden and one large university hospital in the south. The study shows that the treatment in the acute phase is well in line with the recommendations in the report.

Authors' methods: Review

Project Status: Completed

URL for project: http://www.sbu.se/Published

Year Published: 1992

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: Sweden

Organisation Name: Swedish Agency for Health Technology Assessment and Assessment of Social Services

Contact Address: P.O. Box 3657, SE-103 59 Stockholm, Sweden. Tel: +46 8 4123200, Fax: +46 8 4113260

Contact Name: registrator@sbu.se

Contact Email: registrator@sbu.se

Copyright: The Swedish Council on Technology Assessment in Health Care