Secondary stroke prevention: what our survey told us

Many people in our stroke community tell us they worry about having another stroke. That fear of “what if it happens again?” can stay with you for years. So we wanted to look at secondary stroke prevention – what is being done to reduce the risk of another stroke, and whether people are getting the information they need.

What do we know about the risk of another stroke?

According to the NHS, the risk of another stroke is highest in the days and weeks after the first stroke:

Around 2–3% of people have another stroke within the first 30 days
9% within six months
10–16% within the first year
After the first year, the average annual risk is around 5% for the next four years.

What are the risk factors?

Some risk factors can’t be changed. Age is the biggest one, which means younger stroke survivors generally have a lower age-related risk.

Ethnicity is a little different. It can’t be changed, but some of the increased risk is linked to factors that can be managed. Black African and Black Caribbean communities in the UK have a higher risk of stroke, partly because high blood pressure and diabetes are more common, according to research from the South London Stroke Register. This is why regular blood pressure checks and general health monitoring are so important.

Many other risk factors can be reduced through medication, lifestyle changes and regular monitoring. These include high blood pressure, high cholesterol, high blood sugar, obesity, smoking, drinking too much alcohol, poor diet, lack of exercise and atrial fibrillation (AF) – an irregular heartbeat that is responsible for around one in five strokes, according to the Stroke Association.

Why we ran this survey:

We teamed up with Medtronic to find out how much awareness there is of these risk factors among stroke survivors and healthcare professionals. In total, 782 stroke survivors and 96 healthcare professionals took part.

What stroke survivors told us

Healthy eating: 52% said they had received no advice about healthy eating and reducing salt.
Exercise: 44% had received no advice about being active, such as going for a daily 30-minute walk.
Smoking: 49% had received no advice about stopping smoking.
Alcohol: 47% had received no advice about drinking less than 14 units a week.
Blood pressure target (below 130/80): 41% had never been told their target.
Know Your Numbers campaign: 82% had never heard of the blood pressure campaign, and only 7% were fully aware of it.
HbA1c target (below 53): HbA1c is a blood test used to monitor blood sugar levels and diabetes. 80% had never been told their target.
LDL cholesterol target (below 2): 56% had never been told their target.
AF screening: 58% said they had never been screened for atrial fibrillation.
Awareness of AF: Only 50% correctly identified that AF causes around 20–25% of strokes.

What healthcare professionals told us

Know Your Numbers campaign: 40% had not heard of the campaign.
Lifestyle advice: Most healthcare professionals said they always or mostly give advice about healthy eating (63%), exercise (70%), stopping smoking (74%) and reducing alcohol (67%).
Blood pressure target: 58% said they always or mostly discuss blood pressure targets with stroke survivors.
HbA1c and LDL cholesterol targets: Almost half (49%) said they never discuss HbA1c targets, and 36% said they never discuss LDL cholesterol targets.
AF screening: 45% said they never ensure stroke survivors are screened for atrial fibrillation.
Awareness of AF: Encouragingly, 85% correctly identified that AF causes around 20–25% of strokes.

What could these results mean?

Our survey suggests that many stroke survivors may not be getting enough information about some of the biggest risk factors for another stroke.

High blood pressure is the biggest risk factor for stroke, yet many survivors didn’t know their target blood pressure or about the Know Your Numbers campaign. We also found that many people had never been told their HbA1c target, which is used to monitor blood sugar levels and diabetes.

The results also highlight a gap around atrial fibrillation (AF). More than half of survivors said they had never been screened, even though AF is a common cause of stroke and can often be treated once it has been identified.

Encouragingly, healthcare professionals showed a strong understanding of how important AF is, with 85% correctly identifying that it causes around 20–25% of strokes. However, this knowledge doesn’t appear to be reaching every patient.

Together, these findings suggest there is more work to do to make sure people know their targets, receive the right checks and have the information they need to help reduce their risk of another stroke.

Commenting on the findings, Indira Natarajan FRCP(UK), Care Group Medical Director for Unplanned Care at University Hospitals of North Midlands and Clinical Director for Stroke at the Integrated Stroke Delivery Network West Midlands, said:

“As a stroke physician and an ambassador for preventing strokes, I know that every recurrent stroke represents a missed opportunity for prevention. The encouraging message from this survey is that many of the key risk factors can be identified and treated. Our challenge is to ensure every stroke survivor has access to the information, monitoring and support needed to prevent a second stroke and live well after stroke.”

What you can do

If you’ve had a stroke, you don’t have to wait to be offered this information – you can ask for it.

Ask your GP or stroke team about your blood pressure, cholesterol and blood sugar targets, and whether you’ve been screened for AF.
Eat a healthy, lower-salt diet.
Build regular activity into your routine, such as a daily walk or movement.
Stop smoking and cut back on alcohol.
Keep up with medication reviews and regular check-ups.

If anything in this article raises questions or concerns about your own health, please speak to your GP or, if you’re still under one, your stroke team. You know your body best, and you’re entitled to ask for the information you need to help reduce your risk of another stroke.