New research shows that stroke prevention guidelines are outdated and need modernising

Associate Professor Dr Anne Abbott, from the School of Public Health and Preventive Medicine (SPHPM) at Monash University, has led a team of 16 experts in a systematic review of international stroke prevention guidelines and found that recommendations for surgical procedures to prevent stroke are outdated and over-utilised.

Dr Abbott's findings, published this month in the American Heart Association journal Stroke, have significant implications for improved stroke prevention in all patients with narrowing of the main brain artery, known as carotid stenosis, as well as others at risk.

"This research tells us that there is a great opportunity to improve best practice standards for stroke prevention for the benefit of many Australians and people overseas, as arterial disease continues to be the single leading cause of death and disability in westernised countries," Dr Abbott said.

The study analysed 34 current guidelines from 23 regions in six languages and found that guidelines usually endorse carotid procedures (surgery and stenting) to remove narrowings of the internal carotid artery caused by fatty plaques, which are known as carotid stenosis.

"A major weakness of current Australian and international guidelines is that they over-encourage the use of costly carotid procedures which, for many patients, are currently more likely to harm than help. These procedural recommendations are based on studies in which patients were recruited up to three and a half decades ago and overlook the particular hazards of carotid stenting.

"Current guidelines understate the value of modern medical treatment which has seen a drop in stroke rates of up to 80 per cent over the last 30 years," Dr Abbott said.

"Carotid procedures target one artery, while medical treatment helps prevent strokes and all other arterial disease complications because it targets the whole body. Medical treatment encourages healthy lifestyle habits and appropriate medications to reduce risk associated with common conditions, including high blood pressure, high cholesterol, smoking, inactivity, alcohol excess, illicit drugs, and diabetes," Dr Abbott said.

The research, funded by an independent grant from the Bupa Health Foundation and facilitated by the Alfred Hospital, also uncovered significant organisational problems across guidelines. These problems included incomplete definitions and numerous fundamental inconsistencies and omissions.

"Updating health policy and practice by changing the focus of care away from surgery or stenting to non-invasive strategies will better prevent stroke and other complications of heart and arterial disease and this is important for public health and economically sustainable health services."