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Stroke and transient ischaemic attack - Management
How should I follow up someone who has had a stroke or TIA?

Planned follow up

  • Local arrangements should make it clear how this is decided and where the person will be followed up.
  • Follow-up arrangements and frequency depend on individual clinical needs and response to treatment. Where there are no problems requiring more frequent assessments:
    • People who have had a stroke:
      • Schedule primary care follow up (together with the carers) within 6 weeks of discharge home, again within 6 months of discharge, and then annually.
    • People who have had a transient ischaemic attack (TIA) or minor stroke:
      • Follow up within 1 month of the event (in primary or secondary care) and then annually in primary care.

Management

  • Assess the need for further specialist review, advice, information, support, and rehabilitation — see Referral guidance.
  • Assess social care needs.
  • Assess health care needs — see Assessment.
  • Check and optimize lifestyle measures and drug treatments for secondary prevention:
    • Check and record annually blood pressure and lipid profile.
  • Arrange for annual pre-winter influenza immunizations.
Basis for recommendation
  • The recommendations on planned follow-up arrangements are in line with recommendations in the National Stroke Strategy and national guidelines [DH, 2007; Intercollegiate Stroke Working Party, 2008].
  • The recommendations on the frequency of recording blood pressure and lipid profiles are in line with recommendations in national guidelines and reflect the Quality and Outcomes Framework of the General Medical Services contract [BMA and NHS Employers, 2008; Intercollegiate Stroke Working Party, 2008].
  • The recommendation that people who have had a stroke or transient ischaemic attack be offered annual immunization against influenza is from the Chief Medical Officer and is reflected in the Quality and Outcomes Framework of the General Medical Services contract [CMO, 2007; BMA and NHS Employers, 2008].

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