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What is the cost of first time stroke in Australia?
in 1997 555 mill
What is the present value of lifetime cost of stroke?
what is the cost of informal care for stroke survivors?
21.7 million in the first yr after stroke
What are the risks of recurrent stroke in the first year?
- - 10% will have another stroke within a year
- - 5% will have subsequent year for 5
- - 5-10% suffer a heart attack each yr
- If pt manages risk factor decreases the chance of getting another stroke
what is primary stroke prevention?
- preventing people having a stroke eg people with high BP
what is secondary stroke prevention?
when pt has had a stroke and you are trying to prevent another
- - risk factors multiply the risk of stroke
- - reducing one risk factor can significantly reduce stroke risk
Why is it important we understand the stats about strokes?
- - only 31% of stroke survivors identified HTN as a risk for stroke
- - you will probably spend more time with then than any other clinician
- - statistically if their risk factor are not managed we will see them in rehab again
- - 85% of people who have a stroke have high BP
what is the behavioural stroke risk?
- - tobacco smoking
- - high alcohol use
what are the clinical risk factor classification?
- high blood pressure
- - high cholesterol
What are the non modifiable risk factors for stroke?
- - age- 55+ risk of stroke doubles every decade
- - gender- men higher, but women live longer and have more
- - ethnicity- indigenous increase stroke,asain and afican high incidence of haem stroke
- - family history
- - previous stroke
- - socio-economic status
what are the physiological modifiable risk factors for stroke?
- - HTN- increase risk factor 85%, it causes a variety of structural changes, associated with ischemic stroke
- - hypercholesterolaemia- ischemic
- - obestiy
What are the risk factors for modifiable clinical disorders for stroke?
- - AF and CHD- coronary heart disease
- - diabetes
- - carotid atheroscleorisis
- - TIA
- - ABCDD
- - Age > 60 1 point
- - BP > 140/90 Hg 1 point
- - diabetes 1 point
- - unilateral weakness (2 points)
- - speech imapirements
- - duration of symptoms 10-59 min 1 point > 60 2 points
what are the risk factors for stroke?
- - sleep apnoea- can be a symptom
- - depression- can be symptom
- - excessive alcohol-increase blood volume
- - smoking
- - unhealthy diet
- - lack of physical activity
why does smoking increase stroke risk?
- - inflames and irritates the blood vessel walls
- - increase blood aggregability
- - less oxygen is being transported around the body, this leads to increased stress in blood vessels
what advice do u offer a smoker?
- - your best chance of managing your smoking is using combination nicotine replacement therapy
- - at least 7 weeks
- - that is a combination of patches and/ or gums and/ or lozenges and/ or inhalers
- - call quitline
What is zyban?
- - an effective nicotine replacement therapy in quitting
- - it is a prescription drug
- - only works in 1/4 people
- - if it is going to work it will work within 2 weeks
- - cheapest way of quiting
tips for quitting smoking?
- - halve your caffine as zyban doubles ur absorption of cafine
- - eat brekky- sugar helps decrease desire to smoke
- - reduce alcohol- none for the first two weeks
- - caution with warfarin- talk to dr as INR will go up. INR 2-3 = 2 x thinner than normal. More INR = thinner blood
how does diet affect stroke risk?
- - low intake of fruit and veg increases your risk of stroke
- - anti- oxidants
- - folate (B vitamin)
- - potassium- helps controls sodium
- - fibre- help absorbs cholesterol in gut
What are your aims for fruit and veg intake?
- - 5 serves vegies and 2 fruits a day
- - people who have > 5 serves of fruit and veg/ day have a 26% stroke risk reduction
What do dairy products relate with stroke?
- - calcium and potassium in dairy products help with BP
- - 2-3 serves a day
- - 1 serve = 250ml cup of milk
How much bread and cereals should u have a day?
- 58 serves a day
meat/ fish/ chicken/ eggs
- we need at least 1 serve a day for good health
Nuts- contain antioxidants and can lower cholesterol
fats- small amount is needed in a healthy diet
salt- can increase high BP, most salt in our diets comes from packaged foods
implications of being physically inactive and stroke?
- - inactivity accounts for 3- fold increase in risk of stroke
- - PWD more at risk
- - inactivty ranks first as the leading contributor to preventable illness and morbidity in women
- - most studies have focused on endurance type activities
How does exercise prevent stroke?
- - diabetes
- - obesity
- - cholesterol- exercise increases good chol
- - BP
- - depression and social isolation
- - falls and injuries from falls
- But the benefits go once you stop exercise
- 49% are not active enough in aust
How mch exercise should you have?
- national stroke recommendations:
- - 30 mins of moderate intensity activity on most days
- - can be accumulated with no less than 10 min at a time
- mm strengthening exercise- 2/3 days a week, flex and balance 10 min 2/3 days a week hold stretch 10-30 sec
- - energy expenditure- DLW, calorimetric methods (heat loss), HR- not accurate
- - type
- - frequency
- - intensity
- - duration
- - distance etc
- - direct obs
- - motion sensors
- - self report- diaries
- - you must consider all your stroke clincets for ongoing exercise for secondary prevention
- - the clinet must be aware of the exercise prescription guidelines and how to meausre if they are achieving them
- - link you clients with programs and follow them up