A new research study has found a high prevalence of risk factors for patients at six months post stroke, despite the widespread prescription of secondary preventative measures. The ASPIRE-S research study was carried out by researchers from RCSI and funded by the Health Research Board (HRB).

The research set out to assess whether patients who experience an ischaemic stroke (IS) receive the necessary secondary preventative therapy which aims to reduce the risk of future stroke following discharge from hospital.

Ischemic stroke occurs when an artery to the brain is blocked.  The brain depends on its arteries to bring fresh blood from the heart and lungs. The blood carries oxygen and the necessary nutrients to the brain, and takes away carbon dioxide and cellular waste. 

According to the research, a number of important targets for preventative therapy were not being met in Ireland. These included 68% of patients with a BMI greater than 25 (in other words overweight or obese); 16% of patients still smoking; 63% of patients with uncontrolled high blood pressure, 23% with high cholesterol levels; and 28% of diabetic patients with poor control of their condition.

Commenting on the research, Professor David Williams, Head of the RCSI Department of Geriatric Medicine and Consultant Stroke Physician said: “Our research highlights the need to improve the management of preventative interventions for patients after ischaemic stroke to ensure patients lower their risk of another ischaemic stroke. We can do this by streamlining the management of patients, incorporating guidelines into quality assurance cycles in stroke care, educating patients and providing risk management programmes for patients.”

The ASPIRE-S study also found that 57% of patients had cognitive impairment, such as difficulties with memory, visual and executive functioning (published in BMC Neurology, 2015). Many patients reported psychological distress. Despite this high prevalence of cognitive and mood difficulties, almost two-thirds of patients did not receive any form of psychological service either in hospital or in the community. 

A related paper published in the International Journal of Stroke (2015) examined the impact of stroke on family carers of people with stroke. Substantial levels of dissatisfaction with community and hospital services were reported, as well as notable levels of anxiety and depressive symptoms among caregivers, with caregiver and stroke patient well-being found to be strongly interdependent.

Professor Anne Hickey, Head of the Department of Psychology, RCSI said: “Cognitive impairment is associated with a poorer quality of life for patients following stroke and is a significant impediment to patients returning to their activity and engagement levels pre-stroke. The high levels of anxiety and emotional challenges reported by patients’ and caregivers highlights the need for access to psychological services post-stroke as part of routine stroke rehabilitation.”

Stroke is a leading cause of death and disability in Ireland. The WHO estimates stroke is the second most common cause of death and the fourth leading cause of disability.  

The research was led by the Royal College of Surgeons in Ireland (RCSI) and conducted in collaboration with Beaumont Hospital, Connolly Hospital and the Mater Misericordiae University Hospital. The research was published in BioMedCentral Neurology.