Priority 5 Stroke Prevention, Diagnosis, Pre-hospital and Hospital Care

UNCERTAINTY: What is the risk of recurrent stroke, how does this risk change over time, and what can stroke survivors do to reduce the likelihood of having another stroke (i.e. secondary prevention)? (JLA PSP Priority 5)
Overall ranking	5
JLA question ID	0106/5a
Explanatory note	An estimated 30% of people with stroke or TIA have another stroke in the following five years [Ref. 4].(.) and it’s the biggest fear for stroke survivors (from workshop discussions). A 2020 review (see Evidence) looking at risk of recurrence over 10 years concluded that it "varies greatly from 3 months to over 10 years and increases significantly over time in both young and old subgroup" and that the differences "may be explained by follow-up time, regions, age, methodology differences, and stroke types" therefore further exploration is needed. A study looking at a new system for lowering blood pressure - that might have partially addressed this question - had to close early due to COVID-19 [Ref. 5.] Research into the issue of secondary stroke prevention is needed to provide patients and clinicians with information and develop effective interventions for those at risk. Ref 4: Rothwell PM, Coull AJ, Giles MF, et al. Change in stroke incidence, mortality, case-fatality, severity, and risk factors in Oxfordshire, UK from 1981 to 2004. Lancet. 2004;363(9425):1925-33 Ref 5:https://www.stroke.org.uk/research/can-stroke-and-tia-survivors-avoid-further-stroke-using-new-system-lowering-blood-pressure
Evidence	https://pubmed.ncbi.nlm.nih.gov/33040195/
Health Research Classification System category	Stroke

Extra information provided by this PSP
Original uncertainty examples	Is it likely after 8 years you can have another stroke; I take my medication at the correct times and my general health is perfect along with my BM and weight. ~ What are the risks of further stroke? ~ What is the likelihood it will happen again, my Ischemic stroke? ~ What are the chances of a second stroke? ~ If a person has a stroke in their late teens how likely are they to have a relapse or multiple relapses in the future?
Submitted by	Stroke Survivor x 34, Carer x 10, Health/Social Care professional x 27, Research Recommendation x 5, Not stated x 4

Extra information provided by this PSP

Original uncertainty examples

Is it likely after 8 years you can have another stroke; I take my medication at the correct times and my general health is perfect along with my BM and weight. ~ What are the risks of further stroke? ~ What is the likelihood it will happen again, my Ischemic stroke? ~ What are the chances of a second stroke? ~ If a person has a stroke in their late teens how likely are they to have a relapse or multiple relapses in the future?

Submitted by

Stroke Survivor x 34, Carer x 10, Health/Social Care professional x 27, Research Recommendation x 5, Not stated x 4

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