Dorien Brouwer

91 Health education in patients with recent stroke or transient ischemic attack PART 2 Introduction Implementation of preventive treatments and reduction of risk factor exposure at the population level has contributed to a significant reduction of the worldwide age- and gender specific stroke incidence over the past four decades. [1, 2] In the last 20-years, we have seen many improvements in acute stroke treatment modalities as well, including new medications, such as alteplase for intravenous thrombolysis [3] and organized multidisciplinary stroke units. [4] These treatment modalities aim to decrease stroke case fatality and disability. Despite these efforts and achievements, the absolute number of patients with stroke increases, because of the age increase in western populations. As a consequence, the population risk of recurrent vascular events and vascular dementia after transient ischemic attack (TIA) and stroke is increasing considerably, despite successful efforts to decrease the risk of individual patients with stroke, through preventive treatment. [5] Therefore, secondary prevention is an important part of stroke care. An important target for improvement of secondary prevention may be patient awareness of risk factors for stroke and behavior towards modification of risk factors. Health education (HE) is aimed at acquisition of skills and attitudes to change behaviors that influence health, and lead to a modification of risk factors, and to a decrease in disability and case fatality from stroke (Fig. 1). The effect of HE on the desired outcome is influenced by many factors that may be related to the individual patients, their knowledge and skills, their social environment, i.e. family and friends and the accessibility and quality of the healthcare system. The Helsingborg Declaration of 2006 stated that one of the core indicators for the assessment of quality of care is the proportion of patients given adequate advice about a healthy lifestyle. [6] However, HE is still an underdeveloped aspect of stroke care. It is not an accepted part of the secondary prevention programme in clinical practice. Although presently only a few international guidelines provide recommendations for HE in stroke and TIA patients [4] , the number of guidelines that focus on reduction of vascular risk by education and behavioral change is increasing. [4] In many patients, risk factors are not reduced to an optimal compliance with medical regimes [7] and by suboptimal health behavior with regard to diet and physical activity. We estimated the effect of changes in modifiable risk factors from typical to optimal, on the risk of new vascular events in patients with a recent TIA or stroke (Table 1).