Abstract
BackgroundStrategies are needed to improve adherence to the blood pressure (BP) and low-density lipoprotein cholesterol (LDL-C) level recommendations after stroke and transient ischemic attack (TIA). We investigated whether nurse-led, telephone-based follow-up that included medication titration was more efficient than usual care in improving BP and LDL-C levels 36 months after discharge following stroke or TIA.MethodsAll patients admitted for stroke or TIA at Östersund hospital that could participate in the telephone-based follow-up were considered eligible. Participants were randomized to either nurse-led, telephone-based follow-up (intervention) or usual care (control). BP and LDL-C were measured one month after discharge and yearly thereafter. Intervention group patients who did not meet the target values received additional follow-up, including lifestyle counselling and medication titration, to reach their treatment goals (BP < 140/90 mmHg, LDL-C < 2.5 mmol/L). The primary outcome was the systolic BP level 36 months after discharge.ResultsOut of 871 randomized patients, 660 completed the 36-month follow-up. The mean systolic and diastolic BP values in the intervention group were 128.1 mmHg (95% CI 125.8–130.5) and 75.3 mmHg (95% CI 73.8–76.9), respectively. This was 6.1 mmHg (95% CI 3.6–8.6, p < 0.001) and 3.4 mmHg (95% CI 1.8–5.1, p < 0.001) lower than in the control group. The mean LDL-C level was 2.2 mmol/L in the intervention group, which was 0.3 mmol/L (95% CI 0.2–0.5, p < 0.001) lower than in controls. A larger proportion of the intervention group reached the treatment goal for BP (systolic: 79.4% vs. 55.3%, p < 0.001; diastolic: 90.3% vs. 77.9%, p < 0.001) as well as for LDL-C (69.3% vs. 48.9%, p < 0.001).ConclusionsCompared with usual care, a nurse-led telephone-based intervention that included medication titration after stroke or TIA improved BP and LDL-C levels and increased the proportion of patients that reached the treatment target 36 months after discharge.Trial registrationISRCTN Registry ISRCTN23868518 (retrospectively registered, June 19, 2012).
Highlights
Strategies are needed to improve adherence to the blood pressure (BP) and low-density lipoprotein cholesterol (LDL-C) level recommendations after stroke and transient ischemic attack (TIA)
The primary aim of the present study was to investigate whether the NAILED trial intervention improved BP values and LDL-C levels 36 months after stroke or TIA compared to usual care
The baseline characteristics of the participants that are included in the final analysis were well balanced, except for diabetes, which was more common in the control group
Summary
Strategies are needed to improve adherence to the blood pressure (BP) and low-density lipoprotein cholesterol (LDL-C) level recommendations after stroke and transient ischemic attack (TIA). More patients than ever survive strokes, thereby increasing the prevalence of stroke survivors [1]. These patients have an increased risk of new vascular events [2,3,4], but this risk can be reduced by hypertension treatment as well as by statin treatment [5, 6]. Observational studies show that after stroke, only 25 to 49% of all patients reach treatment targets for blood pressure (BP) and only 14 to 77% reach treatment targets for low-density lipoprotein cholesterol (LDL-C) [9,10,11,12,13]. Considering the high prevalence of stroke survivors and the limited available resources for public health care, involving health care professionals other than physicians as well as telemedicine-based strategies might offer alternative cost-effective solutions to improve secondary prevention
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