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Chapter 35: Stroke MTM Data Set

Katherine Vogel Anderson; Sarah E. Honaker

KEY POINTS

KEY POINTS

  • Patients who have had a stroke or transient ischemic attack are at risk for recurrent stroke, myocardial infarction, and death.

  • Smoking cessation, exercise, and weight management are beneficial lifestyle modifications for stroke survivors. Medication therapy management (MTM) providers should reinforce the importance of lifestyle modifications and incorporate these elements, as appropriate, into the medication action plan (MAP).

  • Antihypertensives, statin therapy, antiplatelet agents, and anticoagulants are evidence-based therapies proven to reduce the risk of recurrent stroke. MTM providers should review the medication profile of stroke survivors to identify potential gaps in therapy.

INTRODUCTION TO STROKE

A leading cause of death and disability, stroke affects 800,000 Americans each year.1,2 It is estimated that every 40 seconds, someone in the United States has a stroke, and every 4 minutes, someone dies as a result of a stroke. The majority of strokes are ischemic in nature. Figure 35-1 outlines a classification of stroke by mechanism.2

FIGURE 35-1

A classification of stroke by mechanism with estimates of the frequency of various categories of abnormalities.

Approximately 30% of ischemic strokes are cryptogenic.

Source: Reproduced, with permission, from DiPiro JT, Talbert RL, Yee GC, Matzke GR, Wells BG, Posey L, eds. Pharmacotherapy: A Pathophysiologic Approach. 8th ed. New York, NY: McGraw-Hill; 2011.

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Risk factor modification is paramount for stroke prevention; risk factors for stroke are listed in Table 35-1. Patients who have a stroke or transient ischemic attack (TIA) are at risk for recurrent stroke, myocardial infarction, and death.1 For patients who suffer a stroke, adherence to evidence-based treatment guidelines can prevent death, reduce disability, and improve outcomes. The acute management of stroke is beyond the scope of this chapter. Instead, this chapter will focus on secondary prevention of stroke in the outpatient setting.

TABLE 35-1Risk Factors for Ischemic Stroke
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TABLE 35-1 Risk Factors for Ischemic Stroke

Nonmodifiable Risk Factors or Risk Markers

Age

Low birth weight

Race

Genetic factors

Modifiable, Well Documented

Cigarette smoking

Hypertension

Diabetes

Asymptomatic carotid stenosis

Dyslipidemia

Atrial fibrillation

Sickle cell disease

Poor diet

Obesity

Physical inactivity

Other cardiac diseases (coronary heart disease, heart failure, PAD)

Potentially Modifiable, Less Well Documented

Migraine

Metabolic syndrome

Drug and alcohol abuse

Inflammation and Infection

Elevated Lp(a)

Homocysteinemia

Sleep-disordered breathing

Abbreviations: Lp(a)= lipoprotein(a); PAD= peripheral arterial disease.

Source: Reproduced, with permission, from DiPiro JT, Talbert RL, Yee GC, Matzke GR, Wells BG, Posey L, eds. Pharmacotherapy: A Pathophysiologic Approach. 10th ed. New York, NY: McGraw-Hill; 2017.

Stroke Definitions

  • Stroke – General term for abrupt onset neurological deficit lasting at least 24 hours

  • Ischemic stroke – Occlusion of a cerebral artery caused by a thrombus or embolus

  • Hemorrhagic stroke – Presence of blood in the ...

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