AHA Issues Statement on Nursing’s Role in Psychosocial Health Post-Stroke

The American Heart Association (AHA) has published a scientific statement on the role of nursing in the management of patients’ psychosocial health after a stroke event, as reported in Stroke.

The statement addresses managing depression, stress, anxiety, fatigue, and quality of life (QOL) during the continuum of care after a stroke, which involves their impact, presentation, pathophysiology when known, screening, diagnosis, treatment domains, nursing care, and research gaps.

A literature search was performed for studies on psychological health in stroke from 2018 to 2023, which were reviewed by an AHA writing group.

Patients who have poststroke depression may have impaired executive functioning, problem-solving, psychomotor speed, attention, and memory, and AHA stroke guidelines recommend routine depression screening after a stroke. Effective treatments include early pharmacologic therapy, psychologic treatment/support (including cognitive behavioral therapy), and stroke-specific interventions. Nurses are advised to regularly monitor patients for subtle and overt depressive symptoms, including their severity and potential medication side effects and interactions.

Stress-related symptoms include psychological stress and post-traumatic stress disorder (PTSD). Screening should be initiated in the acute care setting and continued in rehabilitation and ambulatory settings, and nursing professionals should be aware that psychological stress and PTSD symptoms may increase stroke risk and adverse poststroke outcomes. Social support, mindfulness, meditation problem-solving, coping, and psychotherapy may lead to stress reduction.

Anxiety may be associated with unsettling stress and irritation, boredom, concern, anguish, regret, and physical symptoms. Younger age, female sex with lower income, the inability to return to work or resume activities of daily living, social deprivation, cognitive impairment, history of anxiety or depression, and stroke severity are factors associated with increased anxiety levels. Standard screening is recommended because anxiety is frequently underdiagnosed, and treatment includes pharmacologic and psychologic therapies.

Poststroke fatigue may develop any time after a stroke but typically occurs within the first 6 months. It can adversely affect medication adherence, rehabilitation effectiveness, caregiver burden, independence, daily activities, QOL, and mortality. No evidence-based interventions are available to treat patients with poststroke fatigue, and interventions for improving general physical fitness may help prevent, reduce, or treat patients with poststroke fatigue, the AHA authors noted. Stroke survivors should be screened for confounders such as depression, sleep impairment, and medication side effects.

Nurses and interdisciplinary teams are advised to identify interventions that may have a positive effect on patients’ QOL, including mind-body interventions such as yoga, tai chi, and meditation. Research supports an association among psychosocial symptoms, chronic pain, and health-related QOL in patients who have had a stroke. Engaging in social activity and being able to perform activities of daily living independently are key to successful rehabilitation and QOL outcomes.

Research is limited on social determinants of health that can lead to disparities, including structural racism, in poststroke depression, stress, anxiety, fatigue, and QOL, although vascular risk factors and stroke outcomes differ among racial and ethnic groups. Structural inequities may worsen stroke outcomes in under-resourced communities, including Black individuals and those with lower socioeconomic status. Nursing professionals can engage patients in reducing stroke health disparities by improving mental health communication and managing their biases and stereotypes of patients, according to the AHA statement.

“Continued assessment and evidence-based nursing care are essential to minimize adverse psychosocial outcomes after stroke,” the authors wrote.

This article originally appeared on The Cardiology Advisor