Stroke is a chronic disease with acute events

Bruins et al and the accompanying editorial on stroke care make a compelling case for reviewing conventional policy approaches to stroke, which often show a dysequilibrium towards the (very important) front end of stroke, and a relative agnosia for (equally important) aftercare.1 Although it is clearly very important that all should have access to stroke unit care (and thrombolysis for those for whom it is indicated), most patients will still have residual disability after both of these interventions and will be more prone to further strokes than the rest of the population. Comprehensive national audits of stroke care show alarming levels of neglect in terms of chronic disease management and seem to indicate a collective nihilism about the potential for altering function and wellbeing after the early treatment of stroke,2 despite evidence of the effectiveness of continuing therapy and support at long intervals after stroke.3

We need to ensure that the potential for altering functional status and wellbeing is maximised at six months (and beyond). Highlighting the chronic disease aspect of stroke care may best serve this aspiration by promoting a timely focus on prevention, care, and support needs through patient education and empowerment,4 as well as the development of models of care which bring together primary and secondary care.5 This may require a reorientation of practice and training for stroke physicians, which do not currently emphasise the chronic course of the illness, or models of chronic disease management, which promote the role of the patient as partner.