Abstract
Background: Currently there is no standardized guidance on post-stroke management and adherence to secondary stroke prevention guidelines is modest in stroke survivors. We aimed to determine the feasibility of a self-developed evidence-based post-stroke pathway and its impact on secondary stroke prevention and long-term functional outcome. Methods: Acute ischemic stroke patients were prospectively included in a standardized poststroke pathway facilitated by a single certified case manager (CM). The one-year pathway comprised educational discussions on stroke as well as quarterly check-ups for vascular risk factors, life-style changes and adherence to antithrombotic/anticoagulant therapy. The CM intervened when deviations from stroke prevention guidelines were present and if judged necessary. At 12 months, we compared achieved target goals for secondary prevention, functional outcome, stroke recurrence and vascular death with age- and gender-matched controls that received usual post-stroke care. Results: We included 45 cases and 45 controls. At 12 months, the following target goals were more frequently achieved in patients with CM than in controls: blood pressure (100% vs. 46%, p<.001), cholesterol (100% vs. 74%, p<.001) and body-mass-index (67% vs. 46%, p=.053). No differences were found in nicotine abstinence (p=n.s.), HbA1c (p=n.s.) and adherence to antithrombotics/anticoagulants (p=n.s.). CM emerged as an independent predictor of favorable functional outcome (mRS≤2) at 12 months after adjusting for baseline stroke severity and IV thrombolysis (OR: 4.27; 95%CI: 1.2-15.21; p=.025). As opposed to the controls, none of the cases experienced a recurrent stroke (0% versus 13%; p=.003) or suffered from vascular death (0% versus 7%; p=.242) during the follow-up period. Conclusions: Our pilot data suggest that organized post-stroke care may enhance achievement of secondary prevention goals. Its possible effect on stroke recurrence, long-term disability and quality of life is currently investigated in a prospective cohort study.
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