Strokes: progressive stroke pathway

4. Primary Prevention

This refers to interventions aimed at reducing the risk of a stroke in people who have not yet had a stroke. This is distinct from secondary prevention which aims to reduce the risk of a recurrent stroke.

A progressive stroke pathway should focus preventative efforts on the identification and treatment of atrial fibrillation (AF) and raised blood pressure which are of specific importance to reduce the incidence of stroke. Secondary prevention (detection of AF or high blood pressure after stroke) is also important and more fully addressed within Section 7.3: Access to imaging and other investigations.

Actions on other risk factors for cardiovascular disease, including stroke, such as obesity (A Healthier Future: Scotland's Diet & Healthy Weight Delivery Plan 2018) , smoking (Raising Scotland's Tobacco-Free Generation: Tobacco Control Action Plan 2018) and alcohol consumption (Alcohol Framework 2018: Preventing Harm) are covered by other Scottish Government policy commitments and therefore are out of scope for this document.

Improving the primary identification and management of AF and blood pressure will involve a focus on improving data collection in primary care to better measure improvement, supporting community models of detection, and improving access to technology to support self-management.

4.1 Recommendations

1. Encourage improved detection, diagnosis and management of AF and high blood pressure, through quality improvement within primary care and community settings.

2. Support the development of pathways of care for AF which ensure prompt assessment and, where appropriate, treatments including anticoagulation, ablation and left atrial appendage occlusion to reduce the risk of future stroke.

3. Enable the use of proven technology to support detection, tele-monitoring and the provision of tailored self-management support for people with risk factors for stroke such as high blood pressure or AF.