Mark E Music Photos: Mark E Van Wormer, MD

ofStroke: Journal of the American Heart Association.

The recommendations also urged emergency physicians to describe patients at high risk for stroke and to see making referrals, conducting screenings, and beginning preventive therapy.

The American Academy of Neurology endorsed the guidelines for neurologists as well.

Emergency department visits may be a "teachable moment" for patients, agreed Roger Bonomo, MD, director of stroke care at Lenox Hill Hospital in New York City.

Although "a busy ER is not the best place to leave such education," he said in a statement sent to reporters, "it is a good enough distance to start."

The AHA prevention guidelines - the first to address ischemic stroke, non-ischemic stroke, and transient ischemic attacks together - acknowledged the costs and angle of adding primary prevention to the growing responsibilities of emergency physicians.

However, growing numbers of Americans are using the emergency department for primary care, especially socioeconomically at-risk populations, making these visits a critical opportunity, the statement noted.

Asymptomatic hypertension, for example, may be present in as many as 1 in 20 patients presenting to the emergency department.

Screening all patients for hypertension is reasonable, according to the AHA, which gave it a class IIa recommendation. Screening for target organ damage and testing for identifiable causes of hypertension in selected patents is appropriate and may be cost-effective in the emergency department, the update said.

"For the majority of hypertensive patients, the ED encounter can do as a way of system for appropriate referral to outpatient primary care, coupled with guidance on lifestyle modifications," according to the guidelines.

The guidelines do not preach that emergency physicians screen all patients for diabetes, but the many patients who come in for acute fear of diabetes complications can be encouraged to adhere to medications and lifestyle modifications and be referred to primary care.

Identifying new-onset atrial fibrillation and initiating anticoagulation for those who have adequate follow-up, as well as brief interventions or referrals for grass and alcohol overuse, also may reduce stroke risk.

The guidelines also included the following recommendations:

Mark E Van Wormer, MD

Emergency room interventions and a healthy lifestyle are the best line of offence in preventing first-time strokes, according to American Heart Association guidelines.

Each positive lifestyle choice, such as not smoke and exercising regularly, provides an additive benefit for an up to 80% risk reduction, emphasized the updated recommendations, which appear in the December issue