TY - JOUR
T1 - A systematic review and synthesis of global stroke guidelines on behalf of the World Stroke Organization
AU - Mead, Gillian E.
AU - Sposato, Luciano A.
AU - Sampaio Silva, Gisele
AU - Yperzeele, Laetitia
AU - Wu, Simiao
AU - Kutlubaev, Mansur
AU - Cheyne, Joshua
AU - Wahab, Kolawole
AU - Urrutia, Victor C.
AU - Sharma, Vijay K.
AU - Sylaja, P. N.
AU - Hill, Kelvin
AU - Steiner, Thorsten
AU - Liebeskind, David S.
AU - Rabinstein, Alejandro A.
N1 - Funding Information:
The author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: Mansur Kutlubaev, Honoraria for lectures from Pfizer, Abbot Laboratories, Merz. Supported by the Bashkir State Medical University Strategic Academic Leadership Program (PRIORITY-2030). Thorsten Steiner, honoraria for lectures from Bayer, Boehringer, Pfizer, Daiichy, Astra; participation in data monitoring committee or advisory board: Boehringer; leadership role in ESO and WSO. Alejandro Rabinstein, grant for investigator initiated project from Chiesi; CEC committee for Boston Scientific, Advisory boards for Astra Zeneca, Novo Nordisk, Shionogi, Brainomix; leadership role for Life Source (unpaid). Luciano A Sposato, Kathleen and Dr. Henry Barnett Chair in Stroke Research (Western University) Saraydar Neurosciences Fund (Western University); Honoraria from Pfizer Boehringer Ingelheim Gore. Victor C Urrutia, Research grant from Genentech, Inc. Gillian E Mead, honoraria from Imperative Care, Royalties from Elsevier for a book on exercise training after stroke, co-leads Cochrane Stroke which hosts DORIS, President of British and Irish Association of Stroke Physicians. Gisele Sampaio Silva, Medication donation for the Resilient Extend IV trial - to her Institution from Boehringer Ingelheim; personal payment for consulting from Boehringer Ingelheim; honoraria/lectures-personal payment from Boehringer Ingelheim Astra Zeneca and Pfizer; Advisory Board: personal payment from Astra Zeneca. Kolawale Wahab, funding for the Development of Algorithm for management of hypertension in Nigeria and Development of a Training Manual for the treatment of hypertension in Nigeria from Sanofi Pharmaceuticals; Secretary-General, Nigerian Hypertension Society. Laetitia Yperzeele, World Stroke Organisation: Future Stroke Leaders Program funded project on the needs of Young People with Stroke 20.000 USD; Vives Hogeschool and UCLL Genk: Payment for lectures in the course for stroke nurses (payment to her organization, not personal account; World Stroke Organisation: Attendance of WSC 2022 Singapore. Member of the Scientific Board of the Belgian Stroke Council-no funding received. The other authors do not have conflicts of interest.
Publisher Copyright:
© 2023 World Stroke Organization.
PY - 2023/6
Y1 - 2023/6
N2 - Background: There are multiple stroke guidelines globally. To synthesize these and summarize what existing stroke guidelines recommend about the management of people with stroke, the World Stroke Organization (WSO) Guideline committee, under the auspices of the WSO, reviewed available guidelines. Aims: To systematically review the literature to identify stroke guidelines (excluding primary stroke prevention and subarachnoid hemorrhage) since 1 January 2011, evaluate quality (The international Appraisal of Guidelines, Research and Evaluation (AGREE II)), tabulate strong recommendations, and judge applicability according to stroke care available (minimal, essential, advanced). Summary of review: Searches identified 15,400 titles; 911 texts were retrieved, 200 publications scrutinized by the three subgroups (acute, secondary prevention, rehabilitation), and recommendations extracted from most recent version of relevant guidelines. For acute treatment, there were more guidelines about ischemic stroke than intracerebral hemorrhage; recommendations addressed pre-hospital, emergency, and acute hospital care. Strong recommendations were made for reperfusion therapies for acute ischemic stroke. For secondary prevention, strong recommendations included establishing etiological diagnosis; management of hypertension, weight, diabetes, lipids, and lifestyle modification; and for ischemic stroke, management of atrial fibrillation, valvular heart disease, left ventricular and atrial thrombi, patent foramen ovale, atherosclerotic extracranial large vessel disease, intracranial atherosclerotic disease, and antithrombotics in non-cardioembolic stroke. For rehabilitation, there were strong recommendations for organized stroke unit care, multidisciplinary rehabilitation, task-specific training, fitness training, and specific interventions for post-stroke impairments. Most recommendations were from high-income countries, and most did not consider comorbidity, resource implications, and implementation. Patient and public involvement was limited. Conclusion: The review identified a number of areas of stroke care where there was strong consensus. However, there was extensive repetition and redundancy in guideline recommendations. Future guideline groups should consider closer collaboration to improve efficiency, include more people with lived experience in the development process, consider comorbidity, and advise on implementation.
AB - Background: There are multiple stroke guidelines globally. To synthesize these and summarize what existing stroke guidelines recommend about the management of people with stroke, the World Stroke Organization (WSO) Guideline committee, under the auspices of the WSO, reviewed available guidelines. Aims: To systematically review the literature to identify stroke guidelines (excluding primary stroke prevention and subarachnoid hemorrhage) since 1 January 2011, evaluate quality (The international Appraisal of Guidelines, Research and Evaluation (AGREE II)), tabulate strong recommendations, and judge applicability according to stroke care available (minimal, essential, advanced). Summary of review: Searches identified 15,400 titles; 911 texts were retrieved, 200 publications scrutinized by the three subgroups (acute, secondary prevention, rehabilitation), and recommendations extracted from most recent version of relevant guidelines. For acute treatment, there were more guidelines about ischemic stroke than intracerebral hemorrhage; recommendations addressed pre-hospital, emergency, and acute hospital care. Strong recommendations were made for reperfusion therapies for acute ischemic stroke. For secondary prevention, strong recommendations included establishing etiological diagnosis; management of hypertension, weight, diabetes, lipids, and lifestyle modification; and for ischemic stroke, management of atrial fibrillation, valvular heart disease, left ventricular and atrial thrombi, patent foramen ovale, atherosclerotic extracranial large vessel disease, intracranial atherosclerotic disease, and antithrombotics in non-cardioembolic stroke. For rehabilitation, there were strong recommendations for organized stroke unit care, multidisciplinary rehabilitation, task-specific training, fitness training, and specific interventions for post-stroke impairments. Most recommendations were from high-income countries, and most did not consider comorbidity, resource implications, and implementation. Patient and public involvement was limited. Conclusion: The review identified a number of areas of stroke care where there was strong consensus. However, there was extensive repetition and redundancy in guideline recommendations. Future guideline groups should consider closer collaboration to improve efficiency, include more people with lived experience in the development process, consider comorbidity, and advise on implementation.
KW - Stroke rehabilitation
KW - acute stroke care
KW - guidelines
KW - secondary stroke prevention
KW - stroke care
UR - http://www.scopus.com/inward/record.url?scp=85150025904&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85150025904&partnerID=8YFLogxK
U2 - 10.1177/17474930231156753
DO - 10.1177/17474930231156753
M3 - Article
C2 - 36725717
AN - SCOPUS:85150025904
SN - 1747-4930
VL - 18
SP - 499
EP - 531
JO - International Journal of Stroke
JF - International Journal of Stroke
IS - 5
ER -