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Frontiers of Upstream Stroke Prevention and Reduced Stroke Inequity Through Predicting, Preventing, and Managing Hypertension and Atrial Fibrillation: A Call to Action From the Value in Healthcare Initiative's Predict & Prevent Learning Collaborative.

Publication ,  Journal Article
Bufalino, VJ; Bleser, WK; Singletary, EA; Granger, BB; O'Brien, EC; Elkind, MSV; Hamilton Lopez, M; Saunders, RS; McClellan, MB; Brown, N ...
Published in: Circ Cardiovasc Qual Outcomes
July 2020

Stroke is one of the leading causes of morbidity and mortality in the United States. While age-adjusted stroke mortality was falling, it has leveled off in recent years due in part to advances in medical technology, health care options, and population health interventions. In addition to adverse trends in stroke-related morbidity and mortality across the broader population, there are sociodemographic inequities in stroke risk. These challenges can be addressed by focusing on predicting and preventing modifiable upstream risk factors associated with stroke, but there is a need to develop a practical framework that health care organizations can use to accomplish this task across diverse settings. Accordingly, this article describes the efforts and vision of the multi-stakeholder Predict & Prevent Learning Collaborative of the Value in Healthcare Initiative, a collaboration of the American Heart Association and the Robert J. Margolis, MD, Center for Health Policy at Duke University. This article presents a framework of a potential upstream stroke prevention program with evidence-based implementation strategies for predicting, preventing, and managing stroke risk factors. It is meant to complement existing primary stroke prevention guidelines by identifying frontier strategies that can address gaps in knowledge or implementation. After considering a variety of upstream medical or behavioral risk factors, the group identified 2 risk factors with substantial direct links to stroke for focusing the framework: hypertension and atrial fibrillation. This article also highlights barriers to implementing program components into clinical practice and presents implementation strategies to overcome those barriers. A particular focus was identifying those strategies that could be implemented across many settings, especially lower-resource practices and community-based enterprises representing broad social, economic, and geographic diversity. The practical framework is designed to provide clinicians and health systems with effective upstream stroke prevention strategies that encourage scalability while allowing customization for their local context.

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Published In

Circ Cardiovasc Qual Outcomes

DOI

EISSN

1941-7705

Publication Date

July 2020

Volume

13

Issue

7

Start / End Page

e006780

Location

United States

Related Subject Headings

  • United States
  • Stroke
  • Social Determinants of Health
  • Risk Reduction Behavior
  • Risk Factors
  • Risk Assessment
  • Prognosis
  • Primary Prevention
  • Patient Participation
  • Patient Education as Topic
 

Citation

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Chicago
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Bufalino, V. J., Bleser, W. K., Singletary, E. A., Granger, B. B., O’Brien, E. C., Elkind, M. S. V., … American Heart Association Predict & Prevent Learning Collaborative*, . (2020). Frontiers of Upstream Stroke Prevention and Reduced Stroke Inequity Through Predicting, Preventing, and Managing Hypertension and Atrial Fibrillation: A Call to Action From the Value in Healthcare Initiative's Predict & Prevent Learning Collaborative. Circ Cardiovasc Qual Outcomes, 13(7), e006780. https://doi.org/10.1161/CIRCOUTCOMES.120.006780
Bufalino, Vincent J., William K. Bleser, Elizabeth A. Singletary, Bradi B. Granger, Emily C. O’Brien, Mitchell S. V. Elkind, Marianne Hamilton Lopez, et al. “Frontiers of Upstream Stroke Prevention and Reduced Stroke Inequity Through Predicting, Preventing, and Managing Hypertension and Atrial Fibrillation: A Call to Action From the Value in Healthcare Initiative's Predict & Prevent Learning Collaborative.Circ Cardiovasc Qual Outcomes 13, no. 7 (July 2020): e006780. https://doi.org/10.1161/CIRCOUTCOMES.120.006780.
Bufalino VJ, Bleser WK, Singletary EA, Granger BB, O’Brien EC, Elkind MSV, Hamilton Lopez M, Saunders RS, McClellan MB, Brown N, American Heart Association Predict & Prevent Learning Collaborative*. Frontiers of Upstream Stroke Prevention and Reduced Stroke Inequity Through Predicting, Preventing, and Managing Hypertension and Atrial Fibrillation: A Call to Action From the Value in Healthcare Initiative's Predict & Prevent Learning Collaborative. Circ Cardiovasc Qual Outcomes. 2020 Jul;13(7):e006780.

Published In

Circ Cardiovasc Qual Outcomes

DOI

EISSN

1941-7705

Publication Date

July 2020

Volume

13

Issue

7

Start / End Page

e006780

Location

United States

Related Subject Headings

  • United States
  • Stroke
  • Social Determinants of Health
  • Risk Reduction Behavior
  • Risk Factors
  • Risk Assessment
  • Prognosis
  • Primary Prevention
  • Patient Participation
  • Patient Education as Topic