Telestroke for the Long-term Management of Risk Factors in Stroke Survivors

Stroke is a major public health issue worldwide and, being the largest cause of chronic disability in adults , places a significant burden on health care systems. According to the World Health Organisation (WHO), around 15 million people each year suffer a stroke, and 5 million are left with a permanent disability . Over the past two decades, stroke has become an increasingly treatable disease with the development of evidence-based treatments such as tissue plasminogen activator (rt-PA) for the treatment of acute ischemic stroke and admission of patients to stroke units. This has led to a decrease in stroke mortality in developed countries and an increase in the number of survivors with impairment or disability. Stroke is an example of a largely preventable disease that presents acutely, with a short time window within which damage to the brain can be reduced. There is a high risk for residual disability which impacts significantly on society, the patients and their families . Stroke recurrence can lead to a progressive decline into dependency, subsequently placing a significant financial burden on society. In 2008, the indirect and direct costs of stroke in the United States were calculated at $65.5 billion . 87% of strokes are caused by cerebral infarction and are therefore amenable to a number of pre-stroke preventive strategies as well as thrombolytic therapy or intravascular clot retrieval strategies in the acute phase . The second major subtype of stroke, i.e. intracerebral parenchymal haemorrhage, is largely preventable through pre-stroke blood pressure control. In this chapter, we will primarily discuss the current data regarding prevention and limitation of acute brain damage resulting from cerebral infarction, but will also consider other expanding areas in stroke care where telemedicine has a potential role. We will therefore examine the use of telestroke in stroke survivors after discharge from hospital, with particular emphasis on developed models of care and their applicability.