Abstract
Background: Up to 90% of strokes could be prevented by effective treatment of the risk factors. However, there are major problems with the implementation of prevention. For example, only 40% of patients taking medication have blood pressure (BP) at treatment goals and 60% of patients with atrial fibrillation (AF) use anti-coagulant medication. Hypothesis: Remote home monitoring of risk factors after minor stroke or TIA may lead to better control of risk factors by increasing measurements and patient awareness and uncovering undetected risk factors. This pilot study investigates the feasibility of home monitoring of risk factors after minor stroke or TIA. Methods and Patients: Patients (n=30, mean age 57 yrs, range 34-79, 37% females) with recent minor stroke or TIA were supplied with a remote home monitoring system at discharge. The system comprised of a cloud backend for data storage and processing, patient user interface (UI), and wireless BP meter and light-weight EKG device with secured connection to clinician UI, through which BP and EKG could be followed real-time and individualized alarm limits could be set. EKG was automatically analyzed in the cloud backend to detect AF. The patients were contacted by phone at two weeks by stroke nurse and they returned the remote home monitoring system at final visit at three months. Additionally they were contacted if AF was detected or their BP required medication adjustment. Results: Twenty-nine (97%) patients completed the study. One patient discontinued due to unrelated serious illness. One patient did not follow the monitoring program. Of the remaining 28 patients (93%) with complete monitoring data, BP medication needed adjustment in 11 patients (39%) and new AF was detected in 3 patients (11%). Patients appraised that the home monitoring system was easy to use (score 8.6/10) and most would recommend it to peers (score 8.9/10). Conclusions: Remote home monitoring of risk factors after minor stroke or TIA is feasible and may be an efficient way to improve secondary prevention.
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