Priority 1 Stroke Prevention, Diagnosis, Pre-hospital and Hospital Care

UNCERTAINTY: What are the best interventions to stop stroke happening for the first time (i.e. primary prevention)? (JLA PSP Priority 1)
Overall ranking	1
JLA question ID	0106/1a
Explanatory note	100,000 people have strokes each year in the UK [Ref. 1]. Stroke prevalence is predicted to rise particularly in older populations, along with associated costs to health and social care [Ref. 2]. Stroke can happen at any age and is linked with lifestyle and other health factors and conditions (eg. diet, exercise, smoking, high blood pressure, diabetes, patent foramen ovale, dementia, congenital heart disease - see original submissions). However, there is very limited evidence on effective stroke prevention interventions across the entire UK population (see Evidence). Evidence for primary prevention interventions is needed to reduce the impacts of stroke for individuals, and health and social care services. Ref 1: https://www.stroke.org.uk/stroke/statistics Ref 2: King D, Wittenberg R, Patel A, Quayyum Z, Berdunov V, Knapp M. The future incidence, prevalence and costs of stroke in the UK. Age and Ageing 2020; 1-6 (Online first 19 January 2020) https://doi.org/10.1093/ageing/afz163
Evidence	https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD011207.pub2/full https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD012415.pub2/full https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD009586.pub3/full?highlightAbstract=screen%7Cscreening%7Caf https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD009009.pub3/full?highlightAbstract=cheque%7Chealth%7Ccheck%7Cchequ https://doi.org/10.1002/14651858.CD006187.pub3 https://doi.org/10.1002/14651858.CD000213.pub3
Health Research Classification System category	Stroke

Extra information provided by this PSP
Original uncertainty examples	When stroke is a complication of endocarditis, how is the risk of stroke lowered? ~ How do we prevent chronic cerebrovascular disease leading to highly prevalent, late onset vascular cognitive impairment? ~ Can we learn more about the behaviour of a blood clot after thrombolysis to better predict those patients at risk of haemorrhagic transformation? ~ How can this information guide the hyper acute care of patients who have been thrombolysed? for example - when is it appropriate to mobilise and start rehabilitation or restart certain medications? ~ Are there improved outcomes from patients receiving secondary prevention advice from a dietician versus written leaflet/spoken information provided by medics/stroke nurses?
Submitted by	Health/social care professional x 33, Stroke Survivor x 61, Carer x 17, Not stated x 4, Research Recommendations x 8

Extra information provided by this PSP

Original uncertainty examples

When stroke is a complication of endocarditis, how is the risk of stroke lowered? ~ How do we prevent chronic cerebrovascular disease leading to highly prevalent, late onset vascular cognitive impairment? ~ Can we learn more about the behaviour of a blood clot after thrombolysis to better predict those patients at risk of haemorrhagic transformation? ~ How can this information guide the hyper acute care of patients who have been thrombolysed? for example - when is it appropriate to mobilise and start rehabilitation or restart certain medications? ~ Are there improved outcomes from patients receiving secondary prevention advice from a dietician versus written leaflet/spoken information provided by medics/stroke nurses?

Submitted by

Health/social care professional x 33, Stroke Survivor x 61, Carer x 17, Not stated x 4, Research Recommendations x 8

PSP information
PSP unique ID	0106
PSP name	Stroke prevention, diagnosis, pre-hospital and hospital care
Total number of uncertainties identified by this PSP.	93 (To see a full list of all uncertainties identified, please see the detailed spreadsheet held on the JLA website)
Date of priority setting workshop	30th April 2021