In addition to addressing the primary reason for the ED visit, the ED encounter may serve to reinforce healthy living, to per- form primary disease identification and prevention, to provide early disease detection (secondary prevention), to encourage and facilitate compliance with disease management, and to refer patients to primary care providers for continued management of existing disease (tertiary prevention).896,897 With the growing num- bers ofAmericans using the ED for primary care, especially socio- economically at-risk populations, the ED may present a unique opportunity to reduce cerebrovascular disease and CVD.898 Enthusiasm to use the ED as a site for initiating primary and secondary preventative services, however, must be tempered by the higher cost of providing care in this setting and per- formance pressures on the ED personnel to decrease length of stay, rates of patients who leave without treatment, overall wait times, and resource use.896,899 Although the list of potentially modifiable stroke risk factors as reviewed in this guideline is extensive, not all are amenable to assessment and initiation of preventive strategies in the ED.896 Aside from resource avail- ability, to effectively initiate primary preventive strategies, ED personnel must know the risk factors for various diseases, in this case stroke; must understand the appropriate diagnostic evaluations and definitions for the risk factors; must be aware of recommendations for appropriate interventions; and must be able to arrange primary care follow-up to assess the effect of initiated preventive interventions. Adding delivery of primary care and primary prevention to the growing list of mandated interventions delivered in the ED setting will require engaging and enabling already largely receptive ED professionals.900 ED visits serve as opportunities to screen and potentially treat patients with asymptomatic hypertension. 