How can I effectively counsel patients with a PFO regarding their risk of recurrent stroke and the need for follow-up?

Counseling patients with a patent foramen ovale (PFO) regarding their risk of recurrent stroke and the need for follow-up involves clear communication about the potential risks and management options.

Explain that a PFO can be associated with an increased risk of recurrent stroke, particularly if it is linked to paradoxical embolism, but the absolute risk varies depending on individual factors.

Discuss the importance of stroke prevention strategies, including the potential role of anticoagulation or antiplatelet therapy, tailored to the patient's overall risk profile and preferences.

Emphasize the need for regular follow-up to monitor for any new neurological symptoms and to reassess stroke risk, especially if other risk factors such as atrial fibrillation or vascular disease develop.

Advise patients to seek immediate medical attention if they experience symptoms suggestive of stroke or transient ischaemic attack.

Provide written information and support resources to enhance understanding and adherence to management plans.

Where appropriate, refer patients for specialist assessment, including transoesophageal echocardiography (TOE) to better characterize the PFO and guide management decisions.

Ensure shared decision-making is used to discuss the benefits and risks of interventions, including possible closure of the PFO or medical therapy, based on current evidence and patient preferences.