The existing literature includes prospective trials and observa- tional cohorts that demonstrate the effectiveness of a vari- ety of approaches to delivering vascular prevention services. These studies have been designed to evaluate the effect of pri- mary prevention services on the control of risk factors such as hypertension, not on incident stroke rates. Quality improve- ment strategies that are multifaceted and tailored appear to be the most effective. Future research should identify the imple- mentation strategies that are associated with the greatest sus- tained improvements in preventing stroke. Preventive Health Services: Recommendation 1. It is reasonable to implement programs to systemati- cally identify and treat risk factors in all patients at risk for stroke (Class IIa; Level of Evidence A). Summary/Conclusions In this latest iteration of the guidelines, physicians and scientists should take pride in the advances that continue to be made in pre- venting stroke. Medications to control BP and lipids, anticoagu- lants for at-risk individuals with AF, revascularization, cigarette smoking cessation, diet, and exercise are among the interventions broadly applicable to the general public. With so many interven- tions, optimization of stroke prevention for individuals requires systems of care that identify risk factors as they emerge and that gain control of emerging risk factors safely, expeditiously, and cost-effectively. Access to care is necessary but not sufficient to guarantee optimal stroke prevention. Integration of inpatient and outpatient services and incentivizing efforts directed at prevent- ing stroke must also be considered. New recommendations and important revisions are summarized in Table 5. Meschia et al Guidelines for the Primary Prevention of Stroke 3801 Table 5. 