Which risk factors should I assess in patients with a history of stroke to guide their long-term management?

In patients with a history of stroke, the key risk factors to assess for guiding long-term management include:

• Hypertension: Blood pressure control is critical as 50–80% of stroke patients have hypertension, and treatment is highly effective in secondary prevention ¹.
• Atrial fibrillation (AF): Screen for AF as anticoagulation is recommended for secondary prevention in people with paroxysmal or permanent AF ¹.
• Diabetes mellitus: Glycaemic control should be individualized, aiming for HbA1c ≤7% in most patients under 65 without life-limiting comorbidities, using agents with cardiovascular benefit ¹.
• Obstructive sleep apnoea: Screen using validated tools and refer for specialist assessment if suspected, as treatment with CPAP is recommended ¹.
• Lipid levels: Assess and manage dyslipidaemia with high-intensity statin therapy to reduce vascular risk ¹.
• Smoking status: Assess smoking and offer cessation support, including referral to NHS Stop Smoking Services ¹.
• Obesity: Assess weight and refer to weight management services if appropriate ¹.
• Contraception and hormone therapy in women: Avoid combined oral contraceptives in premenopausal women with stroke history due to increased risk; consider progestogen-only or non-hormonal methods ¹.
• Medication adherence and side effects: Review secondary prevention medications including antiplatelets, anticoagulants, and statins, ensuring patient understanding and adherence ¹.

These assessments should be part of regular follow-up at 6 months post-discharge and then annually to review ongoing risk factors and secondary prevention ¹.