Wake Forest Baptist Researcher Says Paradigm Shift Needed in Stroke Recovery Care

Stroke is not only the fifth leading cause of death in the United States, it is also the leading cause of serious long-term disability. 

Among stroke survivors, 25% are readmitted to the hospital within 90 days, 73% have a fall within six months, and 50% do not have their blood pressures controlled, according to Pamela W. Duncan, Ph.D., professor of neurology for Wake Forest School of Medicine, part of Wake Forest Baptist Health.

“Post-acute stroke care in the United States today is variable, fragmented, delivered too often in the silos of health care specialties, and fails to meet our goal of patient-centered care,” said Duncan and co-authors in an article recently published in the American Heart Association journal Stroke. The article was based a lecture Duncan gave in February 2020 when she was the recipient of the American Stroke Association’s David G. Sherman Lifetime Achievement Award.

According to Duncan, there are enormous challenges once a patient is discharged home following a stroke.

“Our biggest challenge is changing the mindset of patients and providers who want a quick fix. Stroke recovery takes time. Most health systems only capture outcomes at hospital discharge.”

Duncan said several multidimensional interventions are needed including individualized care plans, caregiver support and referrals to community resources such as rehabilitation, recovery and lifestyle management programs. 

Additional recommendations to improve post-acute stroke care include:

• Expanding the American Heart Association and American Stroke Association’s Get With the Guidelines program to include post-acute stroke recovery care. Get With the Guidelines is an in-hospital program that promotes consistent adherence to a standard of care to improve patient outcomes. Duncan said these guidelines should include rehabilitation readiness and measure outcomes at 90 days.
• Launching a public health campaign to offer hopeful and actionable messaging on secondary stroke prevention and recovery.
• Assessing and referring patients with unmet social needs to ensure food, financial and other social detriments of health are addressed.

“We can do better,” said Duncan. “Acute care neurologists must be engaged champions for integrated coordinated care to manage stroke recovery and prevention.”