Saturday, 27 May 2017

AHA statement on management of poststroke fatigue

AHA statement on management of poststroke fatigue Fatigue is a debilitating sequelae of stroke, both ischemic and hemorrhagic. About half of all patients who survive an episode of stroke often report fatigue, which may be mild and occurring occasionally to that which is severe and constant. Unlike the typical tiredness, post-stroke fatigue may or may not be related to a recent activity and does not improve with rest. It adversely affects daily activities of life and limits participation of the patients in rehabilitation programs, which in turn hampers recovery. This makes post stroke fatigue an issue that is of concern not only to the affected patient and the caregivers, but also to the clinician taking care of the patient. The American Heart Association (AHA) has published a scientific statement for healthcare professionals on the management of fatigue in patients who have had a stroke. Published May 25, 2017 in the journal Stroke, the statement recognizes the multidimensional nature of poststroke fatigue and lists factors such as old age; female gender; physical impairment and functional deficits; comorbidities such as hypertension, diabetes, kidney disease, heart diseases; medications such as sedatives, antidepressants, and hypnotics and pain as factors that contribute to the fatigue. Patients should be evaluated at the time of discharge from acute care followed by regular follow-up post-discharge at 3 months, 6 months, and 1 year and then yearly. The Fatigue Severity Scale is recommended. These patients should also be evaluated for depression. The statement elucidates the evidence related to the use of tirilazad mesylate, a neuroprotective agent and Modafinil, a drug originally used for patients with hypersomnia or narcolepsy to promote wakefulness, as agents that have shown some efficacy in relieving poststroke fatigue. Vitamin B12, vitamin B1, and idebenone, a synthetic coenzyme Q10 analog may also have a role. Nonpharmacological interventions include aerobic exercise and education of the patients and their caregivers about the condition and the need for exercising, establishing good sleep patterns and avoiding sedating drugs and excessive alcohol The statement also touches upon the impact of fatigue on the caregivers and states that “caregivers can be taught to help the stroke survivor space activities out throughout the day to conserve energy if this is found to be an effective intervention”. (Source: Stroke. 2017;48:e000-e000) Dr KK Aggarwal National President IMA & HCFI

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