Justification

The existence of an updated clinical practice guideline (CPG) on the prevention of stroke can be a useful instrument to address the issues that emerge in health care delivery to healthy patients as well as to those who have previously had a stroke. One of the strategic lines to improve clinical practice (strategy 10) within the Quality National Plan for the National Health System (NHS) is to document and propose initiatives with the aim of decreasing the unjustified variability of clinical practice and to boost the development and use of CPGs linked to health strategies ¹⁴.

The MSC, in accordance with the World Health Organisation’s (WHO) approach and with vascular prevention in general, proposes an integrated approach that combines prevention, diagnosis and treatment of ischemic cardiopathy with the corresponding measures for cancer, diabetes, cerebrovascular diseases and other chronic pathologies, given that many of them share the same risk factors such as smoking, unhealthy diet or physical inactivity, and require similar responses from the health care services of the NHS¹⁴. Within this guideline development programme, throughout the period between 2008 and 2009, two guidelines closely related with vascular prevention will be published: one on type 2 diabetes mellitus and one on prevention of child and adolescent obesity.

2.2. Scope

This CPG tackles primary and secondary prevention of stroke in adults. Acute episodes of stroke, both ischemic (transient ischemic attack [TIA] and brain stroke) and hemorrhagic, have been addressed. Primary prevention refers to strategies or interventions aimed at reducing the risk of having a stroke for the first time, and secondary prevention refers to strategies aimed at those people who have already had a stroke.

On the other hand, this CPG does not include recommendations for the diagnosis, treatment of acute stroke or the organisation of health care services. These aspects are the aim of other guidelines, both in our setting and at an international level (see annex 7).

2.3. Objectives

This guideline has been developed with the following objectives: to provide the professional with recommendations to improve the management of patients with risk of having a stroke or those who have already had one, both at primary and specialised care levels; to develop standards that can be used to assess professional practice, and aid patients in taking informed decisions.

A CPG on primary and secondary prevention of stroke based on the best available evidence can benefit health care professionals by providing guidance in the best management for this situation and in the proper use of available health care resources, and also patients by providing them with homogeneous care and contrasted quality. Patients as well as health care professionals, politicians, health care managers, health care services, and society in general, should have access to those tools that enable the contrast of health care quality and its efficiency, such as this CPG.

These recommendations have been developed by a multidisciplinary team composed of professionals involved in the management of this type of patients and who, prior to the development of the project, have completed and signed a declaration of interests (see annex 6).