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ADVANCES IN CARE FOR PATIENTS WITH STROKE: INTEGRATIVE
REVIEW
Beatriz Alves Torquato1
Elisdárquia Lemos de Almeida2
Jean Lucas Avinte Bentes3
Luisa Virna Monteiro de Abreu4
Liliane Soares5
Nataly de Sousa Martins6
Rafael Melo Lopes7
Raquel Gondim Moreira8
Abstract: Stroke is a medical emergency characterized by the sudden onset of neurological decits,
classied as either ischemic, caused by obstruction of blood ow, or hemorrhagic, due to the rupture
of a cerebral vessel. It remains one of the leading causes of death and disability worldwide, with
early diagnosis being crucial for improving patient outcomes. This study presents an integrative
review of advancements in stroke care, emphasizing the importance of prompt treatment to reduce
complications and enhance functional independence. The review analyzed 14 relevant studies from
the last ve years, sourced from databases like PubMed and Google Scholar. Key ndings highlight
1 Undergraduate in Medicine from Estácio Idomed College in Canindé-Ce
2 Undergraduate in Medicine from Estácio Idomed College in Canindé-Ce
3 Undergraduate in Medicine from Estácio Idomed College in Canindé-Ce
4 Undergraduate in Medicine from Estácio Idomed College in Canindé-Ce
5 Undergraduate in Medicine from Estácio Idomed College in Canindé-Ce
6 Undergraduate in Medicine from Estácio Idomed College in Canindé-Ce
7 Undergraduate in Medicine from Estácio Idomed College in Canindé-Ce
8 Doctor from the Federal University of Ceará, Cardiologist from the Hospital de Messejana,
Responsible for the valvulopathy outpatient clinic and preoperative cardiac and non-cardiac surgery
at the Walter Cantídeo University Hospital; Coordinator of the Medical Clinic Residency - Idomed
Canindé
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the signicance of rapid hospital arrival, early use of MRI to predict cognitive impairments, and
clear communication regarding prognosis. The study also identied barriers in patient care ow,
indicating a need for Continuing Education and improved coordination within the Emergency Care
Network. Effective integration among healthcare professionals is essential to optimize care quality
and rehabilitation outcomes for stroke patients.
Keywords: Stroke; Care; Advances.
INTRODUCTION
Cerebrovascular Accident (CVA) is a condition that results in a sudden neurological decit,
caused by problems in the blood vessels of the central nervous system. There are two main types
of stroke: Ischemic stroke, which occurs when there is a signicant obstruction or decrease in blood
ow in a cerebral artery, often due to a clot, leading to a lack of circulation in the affected area; and
Hemorrhagic stroke, which is the spontaneous rupture of a blood vessel, causing bleeding in the
brain (intracerebral hemorrhage), ventricles (intraventricular hemorrhage) and/or subarachnoid space
(subarachnoid hemorrhage). It is crucial to be aware of the warning signs of a stroke, which include the
sudden appearance of weakness or tingling in the face, arm or leg, especially on one side of the body;
confusion or difculties in speech and comprehension; changes in vision, which can affect one or both
eyes; balance and coordination problems, as well as gait difculties; and intense and sudden headaches,
without an apparent cause (SBAVC, 2021)
Strokes can also be silent, as they have no obvious signs or symptoms, occurring when a
blood vessel in the brain is blocked, leading to cell death. Approximately 25% of people over 80 years
of age have at least one of these infarctions, called “silent infarctions”. This condition becomes more
frequent with age and in individuals who smoke or have vascular diseases. It is estimated that for every
symptomatic stroke, there are 10 silent strokes. Although they are not noticed, these infarctions are
related to subtle difculties in movement and mental processing, in addition to increasing the risk of
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future strokes and dementia. These infarctions can be identied in patients through advanced brain
imaging methods, such as MRI and CT scans (AMERICAN HEART ASSOCIATION, 2024)
Cerebrovascular Accident (CVA) is one of the leading causes of death and disability globally.
Each year, there are about 15 million cases of stroke in the world, of which 5.5 million result in deaths
and 5 million leave sequelae Permanent. In Brazil, the incidence is approximately 108 cases for every
100 thousand inhabitants (BRASIL, 2023).
A systematic review, based on primary studies published in Portuguese, English, and Spanish
between 2011 and 2020, revealed that there have been several advances in hospital care after the
implementation of specic protocols for stroke. However, there is still a need to improve the time it
takes to identify stroke symptoms, both by people who have the rst contact with the patient and by the
professionals involved (LEITE, et al 2022).
According to a meta-analysis study, it was found that direct oral anticoagulants (DOACs)
are related to a lower risk of stroke, systemic embolism, and major bleeding events when compared
to vitamin K antagonists (VKAs) in patients with atrial brillation and liver cirrhosis. The risk of
death from various causes was similar in both groups. These results suggest that DOACs may be an
advantageous alternative to anticoagulation in this group of patients. Although, more research, including
randomized controlled trials, is needed to determine which is the most appropriate DOAC and the best
dosing strategies, especially in patients with advanced liver disease (SINHA, et al, 2024)
GOAL
The purpose of this study is to carry out an integrative review of the advances in the care of
patients with cerebrovascular accident (CVA). This review aims to verify the existing evidence in the
scientic literature on this topic.
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METHODOLOGY
This is a bibliographic research of the integrative review type. This study used the following
guiding question: What advances in the care of patients with stroke? In this sense, to survey the articles
in the literature, a search was carried out in the following databases: PubMed, Google Scholar and
Science Direct and Ministry of Health and Brazilian Stroke Society The following descriptors were
used in Portuguese and English: stroke , care and ‘’advances’’. The inclusion criteria for the selection
of articles were: articles published in Portuguese and English; full articles that were related to the theme
related to the integrative review; and articles published and indexed in these databases in the last 5 years
and systematic reviews.
The exclusion criteria were articles that were more than 5 years old. Thus, 2600 articles were
obtained, with the use of lters, systematic review and articles from the last 5 years dropped to 110,
where of the latter 14 were used to compose the result, as they came closer to the proposed theme.
FINDINGS
YEAR AUTHOR AVC TITLE
2024 Medeiros Ana et all., Present Interventions that change the outcome of the acute phase of stroke
2023 Brandão Paloma,
Lanzoni Gabriela, Pinto
Isabela.
Present
Emergency care network: stroke care Red de atención de
urgencias y emergencias: asistencia a accidentes cerebrovasculares
2021 Sharestani Shane et all., Present A systematic review of next-generation point-of care stroke
diagnostic technologies.
2024 Vasconcelos José et all., Present Emerging Strategies in the Management of Stroke - Perspectives
and Challenges.
2023
Mead Gillian et all., Present A systematic review and synthesis of global stroke guidelines on
behalf of the World Stroke Organization
2022
Sampaio Elieusa et all., Present Factors associated with early arrival time in patients with
ischemic stroke.
2024 Wilhelms Diene et all., Present Integrated approach to the management of ischemic stroke: From
emergency to rehabilitation.
2019 Farias Joelsa Present Care for patients with stroke in a hospital care service: collective
work as a strategy to confront health fragmentation.
2023 Ball Emily et all.,
Present
Predictors of post-stroke cognitive impairment using acute
structural MR I neuroimaging: A systematic review and meta-
analysis
2024 Santos Leticia et all., Present Emergency Approach to Stroke: Rapid Diagnosis and Effective
Intervention to Reduce Sequelae
2022 Leite Karina et all., Present Reducing care time after implementing protocols for acute
ischemic stroke: a systematic review
2024 Jiang Youli et all., Present Advancing stroke patient care: a network meta- analysis of
dysphagia screening efcacy and personalization
2021 Mb Roaldsen, H
Lindekleiv, Eb
Mathiesen
Present
Intravenous thrombolytic treatment and endovascular
thrombectomy for ischaemic wake-up stroke
2024 Azhari Hala Present Advancing strok diagnosis and management through nuclear
medicine: a systematic review of clinical trials
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DISCUSSION
In this study, we saw that stroke is one of the main causes of morbidity and mortality worldwide.
We explored the importance of knowing the factors associated with the time of symptom onset and early
arrival at the hospital of these ischemic stroke patients. This arrival is associated with reduced disability,
increased functional independence, better post-stroke prognosis, and optimization of treatment time.
(Medeiros ana et all., 2024)
This early arrival is associated with favorable clinical outcomes for the patient after stroke.
Factors that favor this early arrival at the hospital were evidenced, such as living in the same city
as the reference hospital, time from symptom onset to seeking the health unit, transport vehicle, and
recognizing signs and symptoms of stroke. This shows a great nding of improvement to reduce patients’
complication rates. (Sampaio Elieusa et all., 2022).
Early stroke MRI can be a valuable tool for healthcare professionals because it will help identify
which stroke survivors are most likely to develop cognitive problems. (Ball Emily et all., 2023)
2019 Farias Joelsa Present Care for patients with stroke in a hospital care service: collective
work as a strategy to confront health fragmentation.
2023 Ball Emily et all.,
Present
Predictors of post-stroke cognitive impairment using acute
structural MR I neuroimaging: A systematic review and meta-
analysis
2024 Santos Leticia et all., Present Emergency Approach to Stroke: Rapid Diagnosis and Effective
Intervention to Reduce Sequelae
2022 Leite Karina et all., Present Reducing care time after implementing protocols for acute
ischemic stroke: a systematic review
2024 Jiang Youli et all., Present Advancing stroke patient care: a network meta- analysis of
dysphagia screening efcacy and personalization
2021 Mb Roaldsen, H
Lindekleiv, Eb
Mathiesen
Present
Intravenous thrombolytic treatment and endovascular
thrombectomy for ischaemic wake-up stroke
2024 Azhari Hala Present Advancing strok diagnosis and management through nuclear
medicine: a systematic review of clinical trials
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In addition, it is crucial to explore whether acute stroke patients are comfortable with receiving
prognostic information. This can benet because knowing your risk of cognitive complications can
inuence your decisions about treatment and rehabilitation. (Ball Emily et all., 2023)
However, the way this data is communicated and the support offered to patients in this
process are extremely important. Realizing the emotional and mental needs of these patients, as well as
maintaining effective communication, will be key to improving the health experience and outcomes of
stroke survivors. (Ball Emily et all., 2023)
This study also highlights the fragmentation in the care services for stroke patients. The care
ow is not visibly dened, and communication between professionals can be effective, but it can face
barriers, varying according to the care professional. Although there are factors that facilitate care,
there are also those that limit, highlighting the need for managerial interventions to improve care,
promoting its standardization and ensuring good service. One of the strategies that can be implemented
is Permanent Education, focusing on stroke and the proper functioning of the Urgent and Emergency
Care Network. (Brandão Paloma et all., 2023).
CONCLUSION
The conclusion of this study emphasizes the relevance of early identication and immediate
care for patients who are victims of ischemic stroke, given that the speed of arrival at the hospital is
directly related to better prognosis and reduction of complications. Factors such as the patient’s location
in relation to the hospital, the time of symptom recognition and the means of transport used are crucial
for this early arrival. MRI also stands out as an important tool for predicting potential cognitive problems
in survivors. In addition, effective communication of prognostic and emotional support information
to patients is critical to successful rehabilitation. The study also highlights the need to improve the
integration of care services, overcoming barriers in communication between professionals and promoting
more standardized and efcient care. Implementing strategies such as Permanent Education can be an
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improved approach to improve the Urgent and Emergency Care Network, beneting the quality of care.
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