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Prevention – uttalad Besparing. hypertoni, läkemedel direkt.

Ingen.

Prevention – hypertonibehandling, främst generika.

Besparing.

Ingen.

Prevention – kolesterolbehandling, främst generika.

Besparing.

Ingen.

Arytmi – warfarinbehandling vid förmaksflimmer.

Besparing 740–1 800 miljoner kronor (engångssumma), besparing 160 miljoner Ingen. kronor per år för hälso- och sjukvården (och 160 miljoner kronor per år för kommunala vården och omsorgen).

Misstänkt stroke eller TIA – omedelbar hänvisning till närmaste sjukhus.

Ökade kostnader.

Ingen.

Trombolys 3–4,5 timmar efter symtomdebut av hjärninfarkt (ischemisk stroke).

Ökade kostnader på 19 miljoner kronor på kort sikt. På lång sikt besparing.

Ingen.

Akut utredning och behandling på sjukhus vid misstänkt TIA.

Initialt ökade kostnader men på sikt besparing.

Visst utökat behov av vårdplatser.

Dekompressiv hemikraniek- Ökade kostnader på tomi vid malign media4–8 miljoner kronor. infarkt.

Ja, både på landstings- och regionnivå.

Multidisciplinärt hemrehabiliteringsteam vid mild till måttlig grad av stroke.

Ökade kostnader.

Ja, kräver organisatorisk förändring.

Skyndsam karotiskirurgi vid Kostnadsneutralt. symtomgivande karotisstenos (vid TIA/lindrig stroke).

Ja, kräver organisatorisk förändring.




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A1

Lågt intag av E-vitamin, betakaroten,omega 3-fettsyror via kosten eller höga homocyteinnivåer hos hjärt-kärlfrisk person

Icke-göra

Kosttillskott med E-vitamin, betakaroten, vitamin B6 och B12 samt omega 3-fettsyror A2

Låg konsumtion av fisk hos hjärt-kärlfrisk person

3

Ökad konsumtion av fisk A3

Hjärt-kärlfrisk person med ett BMI över 35

9

Viktreducerande läkemedelsbehandling där kost- och motionsråd inte gett tillräcklig effekt A4

Hjärt-kärlfrisk person med ett BMI över 40

6

Kirurgisk behandling A5

Hjärt-kärlfrisk patient med systoliskt BT högre än 180 mmHg eller diastoliskt BT högre än 110 mmHg

1

Livsstilsrådgivning samt behandling med ett eller flera generikaläkemedel mot högt blodtryck (diuretika, ACE-hämmare, kalciumantagonister eller betablockerare) A6

Hjärt-kärlfrisk patient med hypertoni och måttligt ökad risk för hjärt-kärlsjukdom där livsstilsinsatser uppenbart har haft otillräcklig effekt

1

Fortsatt livsstilsrådgivning samt behandling med ett eller flera generikaläkemedel mot högt blodtyck )nPHULQIRUPDWLRQLHQV|NEDUOLVWDSnZZZVRFLDOVW\UHOVHQVHQDWLRQHOODULNWOLQMHU




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A7

Hjärt-kärlfrisk patient med hypertoni och lätt ökad risk för hjärt-kärlsjukdom där livsstilsinsatser uppenbart har haft otillräcklig effekt

4

Fortsatt livsstilsrådgivning samt behandling med ett eller flera generikaläkemedel mot högt blodtryck A8

Hjärt-kärlfrisk patient med hypertoni och lätt till måttligt ökad risk för hjärt-kärlsjukdom där livsstilsinsatser uppenbart har haft otillräcklig effekt

10

Fortsatt livsstilsrådgivning samt behandling med ett eller flera icke-generiska läkemedel som förstahandsval mot högt blodtryck A9

Hjärt-kärlfrisk patient med hypertoni där läkemedelsbehandling är indicerad

10

Behandling med angiontensinreceptorblockerare (ARB) som förstahandsmedel A10

Hjärt-kärlfrisk patient med blodfettsrubbning och måttligt ökad risk för hjärt-kärlsjukdom 12 månader efter livsstilsråd

8

Fortsatt livsstilsrådgivning samt behandling med generiskt statin med dokumenterad effekt A11

Hjärt-kärlfrisk patient med blodfettsrubbning och lätt till måttligt ökad risk för hjärt-kärlsjukdom 12 månader efter livsstilsråd

10

Fortsatt livsstilsrådgivning samt behandling med ett icke-generiskt statin som förstahandsval )nPHULQIRUPDWLRQLHQV|NEDUOLVWDSnZZZVRFLDOVW\UHOVHQVHQDWLRQHOODULNWOLQMHU




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A12

Hjärt-kärlfrisk person

Icke-göra

Behandling med acetylsalicylsyra A13

Förmaksflimmer eller -fladder i mer än 48 timmar med ytterligare minst två måttliga riskfaktorer eller en hög riskfaktor för tromboembolisk komplikation oavsett symtom och med beaktande av risk för blödning

2

Tromboemboliprofylax med warfarin A14

Förmaksflimmer eller -fladder i mer än 48 timmar med minst ytterligare en måttlig riskfaktor för tromboembolisk komplikation oavsett symtom och med beaktande av risk för blödning

4

Tromboemboliprofylax med warfarin A15

Förmaksflimmer eller -fladder i mer än 48 timmar med minst två måttliga riskfaktorer eller en hög riskfaktor för tromboembolisk komplikation oavsett symtom där warfarin är möjligt

Icke-göra

Tromboemboliprofylax med acetylsalicylsyra (75–325 mg/dag) A16

Förmaksflimmer eller -fladder i mer än 48 timmar eller paroxysmalt med minst ytterligare en måttlig riskfaktor för tromboembolisk komplikation oavsett symtom där warfarin inte är lämpligt

5

Tromboemboliprofylax med acetylsalicylsyra (75–325mg/dag) )nPHULQIRUPDWLRQLHQV|NEDUOLVWDSnZZZVRFLDOVW\UHOVHQVHQDWLRQHOODULNWOLQMHU




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A17

Attackvis fÜrmaksimmer och minst ytterligare tvü müttliga eller en hÜg riskfaktor fÜr tromboembolisk komplikation

2

Tromboemboliprofylax med warfarin A18

Attackvis fÜrmaksimmer och minst ytterligare en riskfaktor fÜr tromboembolisk komplikation

Icke-gĂśra

Tromboemboliprofylax med acetylsalicylsyra (75–325mg/dag) A19

FÜrmaksimmer (�lone AF�) hos patient utan annan riskfaktor fÜr tromboembolisk komplikation

Icke-gĂśra

Tromboemboliprofylax med warfarin A20

Asymtomatisk karotisstenos

10

Populationsbaserad allmän screening med ultraljud halskärl A21

Asymtomatisk karotisstenos

4

UndersÜkning med ultraljud halskärl vid fynd av halsblüsljud A22

Asymtomatisk karotisstenos

4

Riktad screening med ultraljud halskärl i gruppen med hÜg (mer än 20 procent) prevalens av karotisstenos A23

Asymtomatisk karotisstenos

7

Riktad screening med ultraljud halskärl i gruppen med medelhÜg (5–20 procent) prevalens )nPHULQIRUPDWLRQLHQV|NEDUOLVWDSnZZZVRFLDOVW\UHOVHQVHQDWLRQHOODULNWOLQMHU




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A24

Asymtomatisk karotisstenos

9

Riktad screening med ultraljud halskärl i gruppen med låg (mindre än 5 procent) prevalens av karotisstenos A25

Asymtomatisk karotisstenos

6

Karotiskirurgi A26

Hjärt-kärlfrisk kvinna

Icke-göra

Postmenopausal östrogenbehandling (i syfte att minska risken för stroke eller annan kärlsjukdom) B1

Misstänkt stroke eller TIA

2

Bedömningsinstrument prehospitalt för ambulanssjukvårdare, sjukvårdsrådgivare eller annan person i närheten av den drabbade B2

Misstänkt stroke eller TIA

5

Information i massmedier till allmänheten om akuta strokesymtom och åtgärder vid misstänkt stroke B3

Akuta strokesymtom

2

Utbildningsprogram för hälso- och sjukvårdspersonal B4

Akuta strokerelaterade symtom

2

Vårdprogram för transport samt omhändertagande i ambulans oavsett om personen får trombolys eller inte )nPHULQIRUPDWLRQLHQV|NEDUOLVWDSnZZZVRFLDOVW\UHOVHQVHQDWLRQHOODULNWOLQMHU




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B5

Möjlig trombolys för person med misstänkt stroke

2

Pre- och inhospitalt vårdprogram för trombolys B6

Misstänkt akut stroke med hypoxemi (syrgasmättnad under 95 procent) vid ambulanstransport

2

Syrgasbehandling med monitorering B7

Misstänkt stroke

FoU

Bedömning av symtom och medicinsk handläggning med hjälp av telemedicin under akutskedet B8

Misstänkt stroke eller TIA

1

Omedelbar hänvisning till närmaste sjukhus av primärvården B9

Multisjuk person i palliativ vård som insjuknar när han eller hon befinner sig i annan vårdform än på strokeenhet

2

Läkarbedömning och ställningstagande till omvårdnad och rehabilitering i befintlig vårdform C1

Misstänkt TIA eller stroke efter läkarbedömning

1

Datortomografi )nPHULQIRUPDWLRQLHQV|NEDUOLVWDSnZZZVRFLDOVW\UHOVHQVHQDWLRQHOODULNWOLQMHU




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C2

Misstänkt TIA eller stroke vid differentialdiagnostiska svårigheter

2

Magnetresonanstomografi hos patient med osäker diagnos efter klinisk bedömning och datortomografi C3

Misstänkt hjärninfarkt

FoU

Diffusions-MR, perfusions-MR eller perfusionsDT inför behandling C4

Patient med TIA eller lindrig hjärninfarkt med symtom från främre kretsloppet (karotisförsörjt territorium) utan kontraindikation för karotiskirurgi

2

Skyndsamt ultraljud C5

Patient med hjärninfarkt eller TIA utan kliniska misstankar om bakomliggande hjärtsjukdom

Icke-göra

Ekokardiografi C6

Patienter med kryptogen hjärninfarkt eller stark klinisk misstanke på kardiell embolikälla

3

Ekokardiografi C7

Plötsligt påkommen huvudvärk och misstanke om subaraknoidalblödning

1

Likvorundersökning eller lumbalpunktion om datortomografin inte verifierar subaraknoidalblödning )nPHULQIRUPDWLRQLHQV|NEDUOLVWDSnZZZVRFLDOVW\UHOVHQVHQDWLRQHOODULNWOLQMHU




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D1

Hjärninfarkt

1

Intravenös trombolys inom 0–3 timmar efter symtomdebut (enligt Läkemedelsverkets gällande kriterier) D2

Hjärninfarkt

2

Intravenös trombolys från 3 till 4,5 timmar efter symtomdebut men för övrigt med samma kriterier som vid nu gällande stroketrombolys* *Denna indikation är under Läkemedelsverkets prövning D3

Misstanke om basilarisocklusion

3

MR- eller CT-angiografi D4

Hjärninfarkt orsakad av basilarisocklusion

3

Intravenös eller intraarteriell behandling med trombolys D5

Hjärninfarkt inom mediaterritoriet

FoU

Intraarteriell trombolys och andra endovaskulära tekniker för reperfusion (återställande av blodflöde) D6

Hjärninfarkt i akutskedet

2

Acetylsalicylsyra D7

Hjärninfarkt

Icke-göra

Högdos ofraktionerat heparin )nPHULQIRUPDWLRQLHQV|NEDUOLVWDSnZZZVRFLDOVW\UHOVHQVHQDWLRQHOODULNWOLQMHU




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D8

Hjärninfarkt

Icke-göra

Högdos av lågmolekylärt heparin D9

Progredierande stroke

Icke-göra

Heparinbehandling D10

Basilarisocklusion

Icke-göra

Heparinbehandling D11

Hopade TIA

Icke-göra

Heparinbehandling D12

Patient som väntar på karotiskirurgi

Icke-göra

Korttidsbehandling med antikoagulantia D13

Misstänkt TIA

1

Akut utredning och behandling på sjukhus D14

Subaraknoidalblödning

1

Intensivvård (gäller alla sjukhus) eller utredning och behandling på neurokirurgisk klinik D15

Subaraknoidalblödning

2

Kalciumantagonister D16

Ytligt lobärt intracerebralt hematom (supratentoriellt) med expansiv effekt och påverkad vakenhet

3

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D17

Annan typ av lobärt intracerebralt hematom (supratentoriellt)

9

Neurokirurgi D18

Expansivt cerebellärt hematom

2

Neurokirurgi D19

Hjärnblödning under behandling med perorala antikoagulantia (warfarin)

2

Reversering av antikoagulantiaeffekt med koagulationsfaktorkoncentrat kombinerat med K-vitamin D20

Hjärninfarkt med expansiv effekt (malign mediainfarkt) hos patienter under cirka 60 år

2

Dekompressiv hemikraniektomi inom 48 timmar efter insjuknandet D21

Hjärninfarkt med expansiv effekt (malign mediainfarkt) hos patienter över cirka 60 år

FoU

Dekompressiv hemikraniektomi inom 48 timmar efter insjuknandet D22

Expansiv cerebellär infarkt

4

Neurokirurgi (dekompression och ventrikeldränage) D23

Dissektion i cerbrala kärl

FoU

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D24

Misstänkt sinustrombos

3

Magnetkameraundersökning D25

Sinustrombos

4

Behandling med antikoagulantia E1

Stroke

1

Vård på strokeenhet E2

Stroke

Icke-göra

Vård på vanlig vårdavdelning eller med mobilt stroketeam vid akut stroke E3

Stroke

3

Bedömning och vid behov träning av ADLfunktion E4

Patient med stroke som efter akutfasen har kvarvarande rehabiliteringsbehov

2

Vård på teambaserad rehabilitering i slutenvård E5

Person med mild till måttlig grad av stroke

3

Tidig understödd utskrivning från sjukhus till hemmet med multidisciplinärt rehabiliteringsteam med strokekompetens inklusive läkare som ger rehabilitering i hemmet

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E6

Person med hjärninfarkt eller TIA

Icke-göra

Kliniskt inte motiverad kardioskopövervakning som hindrar tidig mobilisering E7

Hjärninfarkt eller TIA hos person utan kontraindikation mot antikoagulantia

4

Arytmiscreening med Holter-EKG eller Holterevent-recorder för att upptäcka paroxysmalt förmaksflimmer E8

Akut hjärninfarkt

FoU

Blodtryckssänkande behandling i akutskedet E9

Intracerebral blödning i akutfasen

9

Försiktig blodtryckssänkande behandling E10

Måttligt förhöjt blodsocker vid akut stroke

FoU

Normalisering av blodsocker med glukosinsulin-dropp E11

Förhöjd kroppstemperatur i akutskedet av ett stroke

2

Utredning och om möjligt behandling av bakomliggande orsak E12

Akut hjärninfarkt

FoU

Behandling med hypotermi )nPHULQIRUPDWLRQLHQV|NEDUOLVWDSnZZZVRFLDOVW\UHOVHQVHQDWLRQHOODULNWOLQMHU




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E13

Patient med stroke och syrgasmättnad under 95 procent (med hypoxi)

2

Diagnostisering av orsak och om möjligt behandling E14

Patient med stroke och syrgasmättnad över 95 procent (utan hypoxi) under akutskedet

Icke-göra

Syrgasbehandling E15

Stroke med försämring

1

Identifiering och behandling av komplicerande faktorer E16

Stroke

1

Bedömning av sväljningsförmåga E17

Stroke med misstänkt eller verifierad dysfagi

FoU

Rutinmässig diagnostik med videofluoroskopi eller fiberendoskopi E18

Dysfagi vid stroke

3

Åtgärder för behandling och uppföljning E19

Svårigheter att inta vätska och näring

1

Nasogastrisk sond som sätts in inom tre dygn efter stroke E20

Svårigheter att inta vätska och näring och när nasogastrisk sond inte fungerar

1

Perkutan enteral gastro-sond under den första tiden efter stroke )nPHULQIRUPDWLRQLHQV|NEDUOLVWDSnZZZVRFLDOVW\UHOVHQVHQDWLRQHOODULNWOLQMHU




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E21

Svürigheter att inta vätska och näring

Icke-gĂśra

Perkutan enteral gastro-sond som fĂśrstahandsval E22

Urinretention

1

BlĂĽstĂśmning E23

Urineringsproblem vid stroke i akutskedet

2

Klinisk bedĂśmning och vid behov icke-invasiv diagnostik med ultraljud E24

Urinerings- och tarmtĂśmningsproblem vid stroke

4

Utredning och ütgärder enligt program fÜr behandling och uppfÜljning E25

Urineringsproblem vid stroke

6

Professionellt omhändertagande (personal med särskild kunskap om inkontinensproblematik pü avdelning eller mottagning och strukturerat program) E26

Urininkontinens vid stroke

9

Farmakologisk behandling E27

Risk fĂśr trycksĂĽr vid stroke

2

RiskbedÜmning och vid behov fÜrebyggande ütgärder E28

Konstaterade trycksĂĽr vid stroke

2

Behandling (vändschema, nutrition, madrasser) )nPHULQIRUPDWLRQLHQV|NEDUOLVWDSnZZZVRFLDOVW\UHOVHQVHQDWLRQHOODULNWOLQMHU




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E29

Risk för kontrakturer (sängliggande patienter)

9

Vilopositionering för att förebygga komplikationer E30

Risk för kontraktur eller tonusökning

6

Bedömning (neglekt, känsel, tonus, motorik och spasticitet) E31

Risk för kontrakturutveckling

6

Vidmakthålla ledrörlighet E32

Konstaterad kontraktur

6

Vidmakthålla ledrörlighet E33

Risk för fall hos person med stroke

3

Bedömning och förebyggande åtgärder E34

Akut hjärninfarkt med benpares eller oförmåga att gå

2

Behandling med lågdos lågmolekylärt heparin för att förebygga venös tromboembolism E35

Person som insjuknat i stroke och har nedsatt motorisk förmåga

Icke-göra

Kompressionsstrumpa som förebyggande behandling mot djup ventrombos E36

Akut stroke med förvirring

Icke-göra

Neuroleptikabehandling )nPHULQIRUPDWLRQLHQV|NEDUOLVWDSnZZZVRFLDOVW\UHOVHQVHQDWLRQHOODULNWOLQMHU




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E37

Stroke

2

Analys och kvalitetssäkring av strokesjukvürden genom deltagande i kvalitetsregister, som RiksStroke, Auricaula, Swedvasc och WebRehab Sweden. F1

Lätt minnesstÜrning vid stroke

8

Kompensatoriska tekniker F2

SvĂĽr minnesstĂśrning vid stroke

10

Minnesträning F3

Uppmärksamhetsproblem efter stroke

9

Kognitiv träning F4

Spatial neglekt efter stroke

6

Träning i visuell avsÜkning F5

StĂśrning i problemlĂśsnings- och exekutivfĂśrmĂĽga hos person med stroke

7

Systematisk träning av problemlÜsningsstrategier genom kompensatoriska tekniker F6

Nedsatt balans och gĂĽngfĂśrmĂĽga efter stroke

2

Träning med sjukgymnastik F7

Nedsatt motorisk fĂśrmĂĽga efter stroke

3

UppgiftsspeciďŹ k träning )nPHULQIRUPDWLRQLHQV|NEDUOLVWDSnZZZVRFLDOVW\UHOVHQVHQDWLRQHOODULNWOLQMHU




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F8

Spasticitet

8

Fysikaliska metoder F9

Spasticitet som orsakar symtom eller komplikationer

8

Farmakologisk behandling F10

Grav spasticitet som orsakar symtom eller komplikationer

8

Botulinumtoxin F11

Spasticitet efter stroke

Icke-gĂśra

Peroralt baklofen F12

GĂĽngproblem efter stroke

10

Träning pü automatiserad güngbana med avlastning av kroppsvikt F13

GĂĽngproblem efter stroke

8

Träning med elektromekanisk güngträning i kombination med annan sjukgymnastik F14

Avsaknad av viljemässiga muskelkontraktioner vid stroke

10

Funktionell elektrisk stimulering F15

Avsaknad av dorsalektion i fotleden vid stroke hos patient som ej kan gü pü grund av droppfot eller sned belastning

5

Fotledsortos som mĂśjliggĂśr gĂĽngfĂśrmĂĽga )nPHULQIRUPDWLRQLHQV|NEDUOLVWDSnZZZVRFLDOVW\UHOVHQVHQDWLRQHOODULNWOLQMHU




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F16

SvĂĽrigheter att utfĂśra rĂśrelser vid stroke

10

Biofeedback med EMG F17

Stroke

Icke-gĂśra

Akupunktur som strokebehandling F18

Nedsatt motorisk fĂśrmĂĽga vid stroke

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Farmakologisk behandling som ska ge bättre motorik F19

Stroke med kvarstüende nedsättning av ADL-funktion

1

ADL-träning i hemmet efter utskrivning F20

Stroke

3

BedÜmning av kommunikationsfÜrmüga (afasi, pragmatisk sprükstÜrning, dysartri) och information till närstüende och vürdpersonal F21

Nedsatt läsfÜrmüga vid stroke

9

Lästräning vid dator F22

Nedsatt kommunikationsfĂśrmĂĽga vid stroke

5

Kommunikationsträning F23

SvĂĽr afasi vid stroke

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F24

Dysartri vid stroke

8

Individuell träning och gruppträning F25

Dysartri eller nedsatt kommunikationsfĂśrmĂĽga vid stroke

4

Alternativa kommunikationssätt (till exempel hjälpmedel) F26

Ă–kad emotionalitet efter stroke, depression vid afasi eller depression

4

Farmakologisk behandling F27

Dysinhibition och ĂĽngest efter stroke

6

Behandling med SSRI F28

Dysinhibition och ĂĽngest (till exempel aggressivitet och irritabilitet) vid stroke

3

Information till närstüende F29

Central smärta vid stroke

5

Farmakologisk behandling med tricykliska antidepressiva läkemedel (amitryptilin) eller med lamotrigin F30

Central smärta efter stroke

FoU

Behandling med andra preparat än tricykliska antidepressiva, exempelvis SSRI-preparat, gabapentin F31

Smärta i skuldran efter stroke

10

Funktionell elektrisk stimulering )nPHULQIRUPDWLRQLHQV|NEDUOLVWDSnZZZVRFLDOVW\UHOVHQVHQDWLRQHOODULNWOLQMHU




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F32

Smärta i skuldran efter stroke

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Sensorisk stimulering (med massage) F33

Smärta i skuldran efter stroke

6

TENS, akupunktur F34

Risk fÜr smärta i skuldran efter stroke

8

Avlastande hjälpmedel fÜr armen i fÜrebyggande syfte F35

Smärta i skuldran efter stroke

10

Avlastande hjälpmedel fÜr armen som behandling av smärta F36

Patient som insjuknat i stroke

4

Strukturerad information och utbildning riktad till närstüende F37

Närstüende till strokedrabbad person

5

Praktisk handledning och träning F38

Närstüende till strokedrabbad person

9

Emotionellt och praktiskt stĂśd i hemmet G1

HÜgt eller normalt blodtryck (sekundärprevention)

2

Rüd om livsstilsfÜrändringar samt blodtryckssänkning med ACE-hämmare och diuretika )nPHULQIRUPDWLRQLHQV|NEDUOLVWDSnZZZVRFLDOVW\UHOVHQVHQDWLRQHOODULNWOLQMHU




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G2

HĂśga eller normala blodfetter hos patient med ischemiskt stroke

3

Rüd om livsstilsfÜrändringar samt blodfettssänkning med generiskt statin G3

HĂśga eller normala blodfetter hos patient med ischemiskt stroke

7

Rüd om livsstilsfÜrändringar samt blodfettssänkning med icke-generiskt statin G4

Icke-embolisk hjärninfarkt eller TIA

3

Behandling med acetylsalicylsyra G5

ASA-svikt (acetylsalicylsyrasvikt) hos patienter som saknar kardiell embolikälla

Icke-gĂśra

Byte till klopidogrel eller antikoagulantia G6

Icke-embolisk hjärninfarkt eller TIA vid Üverkänslighet mot acetylsalicylsyra

3

Behandling med klopidogrel G7

Icke-embolisk hjärninfarkt eller TIA

4

Behandling med dipyridamol och acetylsalicylsyra i kombination istället fÜr enbart acetylsalicylsyra G8

Hjärninfarkt eller TIA

Icke-gĂśra

LĂĽngtidsbehandling med klopidogrel i kombination med acetylsalicylsyra )nPHULQIRUPDWLRQLHQV|NEDUOLVWDSnZZZVRFLDOVW\UHOVHQVHQDWLRQHOODULNWOLQMHU




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G9

Icke-embolisk hjärninfarkt eller TIA

Icke-gĂśra

LĂĽngtidsprofylax med antikoagulantia G10

FÜrmaksimmer hos patient med tidigare hjärninfarkt eller TIA

2

Warfarinbehandling G11

Antiokoagulationsbehandling

3

Självmonitorering och självadministrering till selekterade patienter G12

Symtomgivande müttlig karotisstenos (50–69 procent enligt NASCET) utan kontraindikation hos patient med TIA eller lindrig stroke

4

Skyndsam karotiskirurgi G13

Symtomgivande hÜggradig karotisstenos (70–99 procent enligt NASCET) utan kontraindikation hos patient med TIA eller lindrig stroke

1

Skyndsam (inom 14 dagar) karotiskirurgi G14

Symtomgivande karotisstenos mindre än 30 procent (stenosgrad enligt NASCET), respektive 30–49 procent (stenosgrad enligt NASCET)

Icke-gĂśra

Karotiskirurgi G15

Symtomgivande karotisstenos

FoU

Behandling med angioplastik (stent) )nPHULQIRUPDWLRQLHQV|NEDUOLVWDSnZZZVRFLDOVW\UHOVHQVHQDWLRQHOODULNWOLQMHU




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G16

Hjärninfarkt eller TIA

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Homocysteinsänkande vitaminbehandling fÜr att fÜrebygga nya vaskulära händelser H1

FĂśrsta ĂĽret efter stroke

3

Rehabiliterande insatser H2

Patient med stroke mer än ett ür efter insjuknandet

10

UppgiftsspeciďŹ k träning H3

Person med stroke i subakut eller kronisk fas och med viss kvarvarande rĂśrlighet i handled och ďŹ ngrar

9

CIMT (Constraint Induced Movement Therapy) H4

Person med stroke

FoU

ModiďŹ erad CIMT (Constraint Induced Movement Therapy) H5

Lätt till müttlig stroke med bevarad güngfÜrmüga hos yngre personer med lüg risk fÜr hjärtkomplikationer vid träning

4

Günginriktad träning med fokus pü styrka och kondition H6

Nedsatt ADL-fĂśrmĂĽga

3

BedÜmning och utprovning av hjälpmedel inklusive bostadsanpassning )nPHULQIRUPDWLRQLHQV|NEDUOLVWDSnZZZVRFLDOVW\UHOVHQVHQDWLRQHOODULNWOLQMHU




Nationella riktlinjer för strokesjukvård 2009 är ett stöd för dem som ska fatta beslut om prioriteringar inom strokesjukvården. Riktlinjerna granskar och prioriterar olika åtgärder för en rad olika hälsotillstånd (till exempel vård på strokeenhet vid akut stroke), och ger rekommendationer om vilka av åtgärderna som hälso- och sjukvården bör använda. Strokeriktlinjerna är en uppdatering av 2005 års version och ett 40-tal helt nya rekommendationer har tillkommit. Många av de nya rekommendationerna rör centrala delar i strokesjukvården. Här är några exempel. Socialstyrelsen rekommenderar att hälso- och sjukvården bör utföra: • akut utredning och behandling på sjukhus vid misstänkt TIA • behandling med intravenös trombolys som nu kan utföras upp till 4,5 timmar efter symtomdebut av hjärninfarkt • skyndsam karotiskirurgi, inom 14 dagar från symtomdebut, för att förebygga stroke hos patienter som visat symtom från TIA eller lindrig hjärninfarkt Riktlinjerna tar även upp vilka av de centrala rekommendationer som ger ökade kostnader eller besparingar. Dessutom presenteras de indikatorer som har tagits fram och som ska användas vid uppföljning och jämförelser av strokesjukvården.

Nationella riktlinjer för strokesjukvård 2009 – Stöd för styrning och ledning (artikelnummer 2009-11-4) kan beställas från Socialstyrelsens beställningsservice, 120 88 Stockholm www.socialstyrelsen.se/publikationer E-post: socialstyrelsen@strd.se Fax: 08-779 96 67 Publikationen kan också laddas ner/beställas på www.socialstyrelsen.se

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Nationella riktlinjer

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