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HSN Stroke Prevention Clinic

HSN Stroke Prevention Clinic. What is a Secondary Stroke Prevention Clinic. Out-patient hospital-based clinic Provides an individualized, interdisciplinary, evidence-based approach to stroke prevention for those individuals at high risk of stroke to reduce stroke risk

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HSN Stroke Prevention Clinic

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  1. HSN Stroke Prevention Clinic

  2. What is a Secondary Stroke Prevention Clinic • Out-patient hospital-based clinic • Provides an individualized, interdisciplinary, evidence-based approach to stroke prevention for those individuals at high risk of stroke to reduce stroke risk • Provides rapid access to diagnostic testing

  3. What is a Secondary Stroke Prevention Clinic • Identifies individual risk factors and initiates teaching related to risk factor reduction • Provides referrals to necessary specialist (vascular surgery, neurosurgery) • Provides referrals to community prevention and rehabilitation services (nutritional counselling, diabetes education, smoking cessation programs, Short-term Assessment And Treatment (STAT)

  4. Target Population • Individuals who have experienced a Transient Ischemic Attack (TIA) • A stroke warning event • 10-20% risk of stroke within 90 days with ½ of that risk within the first 2 days (Hill & Gladstone, 2008) • TIA precedes 15% of strokes (Gladstone, Kapral, Fang, Lapeast & Tu, 2004) • Opportunity for preventative measures

  5. Health Science North (HSN)Stroke Prevention Clinic Staffing • Staff includes Physicians, Registered Nurses (0.8 FTE) and a Clerk (0.6 FTE) • Current physicians :Dr. Gupta, Dr. Mathew, Dr. Puranam and Dr. McMullen • Physician Clinics: 1-2 clinics/week • RN available: 4 days/week • Urgent Diagnostic Imaging available 5 days/week

  6. Referral Sources FY 2013/14

  7. Case Study 50 year old right handed male Sudden onset of left-sided paresthesia involving the arm and leg and left-sided chest pressure Left arm felt heavy -felt he needed to exert more effort to get it to move No other associated symptoms Lasted 24 hours and resolved Referred to stroke prevention clinic for possible TIA

  8. Risk Factors • MI with PTCA and stent age 45 • Hypertension • Hyperlipidemia • Type 2 diabetes (diagnosed in December 2013) • Mild obstructive sleep apnea • Quit smoking in 2000 (smoked 2 packs/day since high school) • Limited alcohol consumption • Height 174.3 cm Weight 108.4 kg BMI 35.7 kg/m2 • Physically inactive

  9. Role of Clinic Nurse • Triages referrals to determine urgency of visit • Follows medical directive to order diagnostic testing and imaging

  10. ABCD2Triage Tool • All referrals received triaged according to the ABCD2 Scoring Scale (Johnston, Rothwell, Nguyen-Huynh, Giles, Elkins, Bernstein, Sidney,. Lancet 2007)

  11. ABCD2Triage Tool

  12. ABCD2Triage Tool • Triage levels

  13. Medical Directive

  14. Role of Clinic Nurse • Interviews patient prior to physician visit to assess risk factors and lifestyle management issues • Provides information and strategies to modify lifestyle and risk factors • Refers to appropriate community partners for more comprehensive assessments and structured programs to manage risk factors

  15. Prevention of StrokeCanadian Best Practice Recommendation (2012) • Lifestyle and risk factor management • Blood pressure management • Lipid management • Diabetes management • Smoking Cessation • Antiplatelet therapy/Antithrombotic therapy for Atrial Fibrillation • Sleep apnea • Management of carotid disease

  16. Prevention of StrokeCanadian Best Practice Recommendation (2012) Lifestyle and Risk Factor Information and Counselling should include: Healthy balanced diet Sodium Exercise Weight Alcohol consumption Birth control and hormone replacement therapy

  17. Prevention of StrokeCanadian Best Practice Recommendation (2012) Exercise: • Participating in moderate exercise such as walking (ideally brisk walking), jogging, cycling, swimming or other dynamic exercise four to seven days each week in addition to routine activities of daily living • Patients should be counselled to achieve an accumulation of at least 150 minutes of moderate to vigorous activity per week, in episodes of 10 minutes or more

  18. Prevention of StrokeCanadian Best Practice Recommendation (2012) Exercise (cont’d) • Most stroke patients should be encouraged to start a regular exercise program • Supervision by a healthcare professional (physical therapist or cardiac rehab) at exercise initiation should be considered in stroke patients at risk of falls or injury, or in patients with other comorbid disease (such as cardiac disease), which may place them at higher risk of medical complications

  19. Community Partners • Diabetes Education Centre • Nutrition Counselling • Exercise-currently no programs for the SPC to refer patients with other comorbid conditions to for supervised exercise

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