The Many Facets of Postacute Stroke Care

Ischemic stroke affects over 600,000 people in the US annually and remains a leading cause of long-term disability. Although acute interventions, including thrombolysis and thrombectomy, have significantly improved poststroke outcomes, the care that patients receive in the days and weeks after stroke onset is equally important in determining their ultimate outcome. The continuum of postacute stroke care involves the neurologist, physiatrist, therapist, broader care team, and the patient and their surrogates, family members, and other caregivers.

Because this topic also touches on diverse elements of healthcare, ranging from hospital-based treatments, long-term medications, goals of care, and postdischarge rehabilitation, we convened a multidisciplinary group of experts to consider several important topics relevant to poststroke acute care. Although the topics covered are by no means exhaustive, we hope that they are informative for neurologists caring for those with ischemic stroke and provide guidance for what can be a landscape of competing and, potentially, conflicting interests.

Because blood pressure is a central theme of postacute stroke care, Drs Aziz and Mistry provide a practical and guideline-concordant summary of In-Hospital Blood Pressure Control After Acute Ischemic Stroke, covering a variety of poststroke situations including after thrombolysis, thrombectomy, or both. In a similar vein, Drs Anadani, Nelson, and Bruno describe best practices for Hyperglycemia Management following ischemic stroke. The role of Antiplatelet Therapies After Ischemic Stroke for secondary stroke prevention has evolved in the last 5 years, which Drs Indraswari, Dai, Shu, Rana, and Yaghi describe with expert-level detail accompanied by recommendations for evidence-based approaches to specific scenarios such as minor stroke, transient ischemic attack (TIA), or large artery intracranial atherosclerosis.

The role of Lipid Management & Smoking Cessation is discussed in detail by Drs Nankee, Wabnitz, and Turan, who provide much needed clarity on these important topics of secondary stroke prevention. Continuing along the spectrum of postacute stroke care, in Poststroke Rehabilitation Care, Drs Braun and Lai and Mrs. Wright discuss the organization of poststroke rehabilitation, common complications seen after stroke, such as spasticity and urinary retention, and the role of different levels of rehabilitation to maximize recovery. Last, but certainly not least, Dr Hannon delves into the importance of Goals-of-Care & Palliative Approaches for postacute stroke patients, which is an evolving and essential element of postacute stroke care.

The articles in this issue are prescriptive when evidence or guidelines support such an approach but also embrace the uncertainty inherent to many of these topics. Although the clinical care of stroke patients is often informed by a larger evidence base than other neurologic disorders, the complexity of postacute stroke care precludes definitive recommendations in many common scenarios. We hope that the balanced approach to recommendations and, where it is more appropriate, guidance proves informative and that this issue will provide an actionable road map for caregivers.