Collaborative Care for Stroke Prevention: Integrating Pharmacists into Primary and Secondary Prevention Strategies

Milosavljevic Svenson^*
*Correspondence: Milosavljevic Svenson, Department of Pharmacy, Institute of Clinical Sciences, University of Birmingham, Birmingham B15 2TT, UK, Email:

Introduction

Stroke remains one of the leading causes of death and disability worldwide, with millions of individuals suffering from its devastating effects each year. Preventing stroke, particularly through early intervention and management of risk factors, is a crucial public health strategy. Primary prevention focuses on preventing a first stroke in individuals who have no prior history of the event, while secondary prevention involves strategies to prevent recurrent strokes in individuals who have already experienced one. Despite significant advances in medical treatment and risk factor management, many individuals remain at risk due to suboptimal adherence to prevention strategies or lack of access to specialized care [1].

One promising solution to addressing these challenges lies in collaborative care models that integrate healthcare professionals from different disciplines. One such approach involves the incorporation of pharmacists into stroke prevention strategies. Pharmacists, as highly trained medication experts, have the knowledge and skills necessary to assist in the management of stroke risk factors, such as hypertension, hyperlipidemia, diabetes and anticoagulation therapy. By playing an active role in both primary and secondary prevention strategies, pharmacists can improve medication adherence, optimize treatment regimens and provide valuable patient education, ultimately leading to better outcomes for individuals at risk of stroke. This explores the role of pharmacists in stroke prevention, focusing on both primary and secondary prevention strategies. It will highlight the benefits of integrating pharmacists into collaborative care teams, review the evidence supporting their contributions to stroke prevention and discuss practical considerations for implementing this approach in clinical practice [2].

Description

Stroke is a complex medical condition that arises from various etiologies, with both modifiable and non-modifiable risk factors. Common risk factors for stroke include hypertension, smoking, diabetes, atrial fibrillation, high cholesterol and a sedentary lifestyle. Effective management of these risk factors is essential for both primary and secondary prevention. However, research has shown that many individuals with risk factors do not adhere to prescribed medications or lifestyle modifications, resulting in an increased likelihood of stroke occurrence or recurrence. The integration of pharmacists into stroke prevention strategies is a natural extension of their role in healthcare. Pharmacists possess extensive knowledge of pharmacology, medication management and patient counseling, making them uniquely qualified to contribute to stroke prevention efforts. Their involvement can take many forms, including medication therapy management (MTM), patient education, medication adherence monitoring and providing recommendations for drug therapy optimization. Primary stroke prevention aims to prevent the occurrence of a first stroke in individuals who are at high risk. This is typically achieved through the management of risk factors, such as hypertension, high cholesterol, diabetes and atrial fibrillation, among others. Pharmacists play a key role in addressing these risk factors through medication management and patient education [3].

Hypertension is the most significant modifiable risk factor for stroke. Uncontrolled high blood pressure increases the likelihood of both ischemic and hemorrhagic stroke. Pharmacists are well-placed to help manage hypertension by ensuring appropriate medication use, counseling patients on lifestyle modifications and monitoring for side effects of antihypertensive medications. Studies have shown that pharmacist-led interventions can significantly improve blood pressure control in patients. For instance, a study published in The American Journal of Health-System Pharmacy demonstrated that pharmacistled blood pressure monitoring and counseling resulted in better blood pressure control compared to standard care. Pharmacists can also collaborate with primary care providers to adjust medications as needed, ensuring that patients achieve optimal blood pressure targets. High cholesterol, particularly elevated levels of Low-Density Lipoprotein (LDL) cholesterol, is another major risk factor for stroke. Statins, which are commonly prescribed to lower LDL cholesterol, have been shown to reduce the incidence of both first and recurrent strokes. Pharmacists can assist by monitoring patients' lipid levels, educating them about the importance of statin adherence and helping manage potential side effects such as muscle pain or liver dysfunction. Pharmacists can also provide guidance on non-statin therapies, such as ezetimibe or PCSK9 inhibitors, when appropriate. By ensuring that patients are taking their medications as prescribed and addressing any concerns they may have, pharmacists can help optimize cholesterol management and reduce stroke risk [4].

Secondary stroke prevention involves strategies to reduce the risk of a recurrent stroke in patients who have already experienced one. Given the high risk of recurrence in the first few months to years following a stroke, secondary prevention is critical to improving long-term outcomes. Pharmacists can play an essential role in optimizing medication therapy, ensuring adherence and providing education to prevent stroke recurrence. Antiplatelet therapy is a cornerstone of secondary stroke prevention, particularly for patients who have experienced ischemic stroke. Medications such as aspirin, clopidogrel, or a combination of the two are commonly prescribed to reduce the risk of recurrent stroke by preventing blood clots. Pharmacists are integral to ensuring that patients understand the importance of antiplatelet therapy and adhere to their prescribed regimen. Pharmacists can also educate patients about the potential side effects of antiplatelet therapy, such as gastrointestinal bleeding and encourage them to report any signs of bleeding or bruising. Furthermore, pharmacists can collaborate with physicians to assess the need for alternative antiplatelet medications if side effects are problematic. Many patients who experience a stroke have comorbid conditions such as hypertension, diabetes, or high cholesterol. Pharmacists can ensure that these conditions are adequately managed following a stroke. For example, following an ischemic stroke, blood pressure control is critical to preventing further damage to the brain. Pharmacists can work with patients to adjust antihypertensive medications, monitor side effects and reinforce the importance of lifestyle modifications [5].

Conclusion

Stroke prevention, both primary and secondary, requires a multifaceted approach that involves early identification of risk factors, appropriate treatment and ongoing management to reduce the likelihood of occurrence or recurrence. Pharmacists have a unique and valuable role in this process due to their expertise in medication therapy management, patient counseling and chronic disease management. By integrating pharmacists into collaborative care teams, healthcare providers can enhance the effectiveness of stroke prevention strategies, improve medication adherence and ultimately reduce the burden of stroke on individuals and society. The evidence supporting pharmacists’ involvement in stroke prevention is robust, with numerous studies demonstrating that pharmacist-led interventions can significantly improve patient outcomes, including better management of hypertension, cholesterol, diabetes and anticoagulation therapy. Furthermore, pharmacists are wellpositioned to provide education and emotional support, helping patients make informed decisions and adhere to their treatment plans. As healthcare systems continue to evolve, it is essential to embrace collaborative care models that fully leverage the expertise of pharmacists in stroke prevention. By fostering stronger partnerships between pharmacists, physicians and other healthcare professionals, we can create a more effective, patient-centered approach to stroke prevention that ultimately improves quality of life and reduces the incidence of this debilitating condition.

Acknowledgement

None.

Conflict of Interest

There are no conflicts of interest by author.

References

1. Patanwala, Asad E., Arthur B. Sanders, Michael C. Thomas and Nicole M. Acquisto, et al. "A prospective, multicenter study of pharmacist activities resulting in medication error interception in the emergency department." Ann Emerg Med 59 (2012): 369-373.

   Google Scholar, Crossref, Indexed at

2. Mangiapane, Sandra, Martin Schulz, Stephan Mühlig and Peter Ihle, et al"Community pharmacy–based pharmaceutical care for asthma patients." Ann Pharmacother 39 (2005): 1817-1822.

   Google Scholar, Crossref, Indexed at

3. Cesarz, Joseph L., Aaron L. Steffenhagen, James Svenson and Azita G. Hamedani. "Emergency department discharge prescription interventions by emergency medicine pharmacists." Ann Emerg Med 61 (2013): 209-214.

   Google Scholar, Crossref, Indexed at

4. Andres, Jennifer, Olivia Stanton-Ameisen, Sara Walton and Charles Ruchalski. "Pharmacists’ impact on secondary stroke prevention." J Pharm Pract 32 (2019): 503-508.

   Google Scholar, Crossref, Indexed at

5. Barbour, Julia, Patricia Hushen, George C. Newman and Jennifer Vidal. "Impact of an emergency medicine pharmacist on door to needle alteplase time and patient outcomes in acute ischemic stroke." Am J Emerg Med 51 (2022): 358-362.

   Google Scholar, Crossref, Indexed at