Top Things to Know: Addressing Systemic Complications of Acute Stroke
Published: December 05, 2024
- Post-stroke systemic complications are not limited to neurological deficits but also affect multiple organ systems. These include common complications such as fever, infections (e.g., pneumonia and UTIs), respiratory problems, gastrointestinal disturbances, and renal and urinary complications. These complications arise from the stroke itself, adverse treatment effects, and physiological imbalances, complicating the care process.
- Early post-stroke complications are a leading cause of early mortality and long-term disability, with timely recognition and intervention being critical to improving patient outcomes.
- The reported frequency of systemic post-stroke complications ranges between 13.9% and 95%, depending on the study. This variation reflects differences in study methodologies, patient populations, and data collection methods, highlighting the need for standardization in future research to accurately capture the incidence and impact of these complications.
- There is a marked lack of well-conducted randomized controlled trials (RCTs) aimed at preventing or treating systemic complications following stroke, highlighting a critical research gap in stroke care.
- Organized stroke unit care has consistently demonstrated better outcomes, with reduced incidence of systemic complications and lower rates of severe disability and death among stroke patients.
- The Quality in Acute Stroke Care (QASC) RCT demonstrated that implementing protocol-based care, specifically targeting key complications like fever, hyperglycemia, and dysphagia, resulted in significantly better outcomes compared to routine care. The success of these approaches underscores the need for systematic protocols in stroke units.
- Despite strong recommendations for stroke unit care, many stroke survivors do not receive treatment in dedicated stroke units. Fragmented care in real-world settings contributes to disparities in patient outcomes, and addressing these gaps is essential to ensuring that all stroke patients receive the care they need.
- Stroke patients often have complex needs, including cognitive impairments, communication difficulties, and multifaceted physiological issues. Tailoring interventions to address these unique challenges is difficult but crucial for improving outcomes. Care strategies must account for these complexities to be effective.
- Comprehensive care for post-stroke patients requires a multidisciplinary approach, involving experts from various fields such as vascular neurology, neurocritical care, internal medicine, nursing, gastroenterology, and rehabilitation. These teams play a vital role in managing the wide range of systemic complications and ensuring coordinated care.
- There is an urgent need for further research and the development of innovative, system-based care approaches to mitigate post-stroke complications and improve patient outcomes.
Citation
Kumar S, Chou SH-Y, Smith CJ, Nallaparaju A, Laurido-Soto OJ, Leonard AD, Singla AK, Leonhardt-Caprio A, Stein DJ; on behalf of the American Heart Association Stroke Council; Council on Cardiovascular and Stroke Nursing; and Council on Hypertension. Addressing systemic complications of acute stroke: a scientific statement from the American Heart Association. Stroke. Published online December 5, 2024. doi: 10.1161/STR.0000000000000477