Preventing the next stroke: The urgent need for guideline adherence—An integrative review with implications for practice

ABSTRACT Background: Stroke is a major global health issue, causing significant morbidity, mortality, and economic burden. Approximately 11% of individuals experience a recurrence within a year of their initial stroke, resulting in substantial disability and increased health care costs. Secondary stroke prevention is essential in reducing the risk of recurrent strokes and improving patient outcomes, but adherence to prevention guidelines remains inconsistent. Purpose: This integrative review evaluates adherence to the American Heart Association/American Stroke Association (AHA/ASA) guidelines for secondary stroke prevention across various clinical settings. It identifies gaps in adherence, assesses the impact on patient outcomes, and provides insights for improving guideline implementation. Methodology: A comprehensive literature search was conducted across databases including PubMed, CINAHL, Ovid, and Embase. This integrative review used 5-stage framework of Whittemore and Knafl to synthesize findings from quantitative and qualitative research studies on using the guidelines in reducing recurrent stroke. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist served as the reporting guideline. Results: Twenty studies from 2019 to 2020 met inclusion criteria, showing substantial variability in adherence to secondary stroke prevention guidelines. Key findings include a significant proportion of patients not receiving optimal therapies, varying adherence rates across settings, and notable gaps in recommended practice implementation. Conclusions: Adherence to AHA/ASA guidelines for secondary stroke prevention is inconsistent, with several barriers affecting optimal implementation. Addressing these gaps is important in reducing recurrent stroke rates. Implications: Health care providers must stay updated on AHA/ASA guidelines and integrate them into practice to ensure optimal outcomes.