Abstract
BackgroundEnhanced secondary preventive follow-up after stroke or transient ischemic attack (TIA) is necessary for improved adherence to recommendations regarding blood pressure (BP) and low-density lipoprotein cholesterol (LDL-C) levels. We investigated whether nurse-led, telephone-based follow-up was more efficient than usual care at improving BP and LDL-C levels at 12 months after hospital discharge.MethodsWe randomized 537 patients to either nurse-led, telephone-based follow-up (intervention) or usual care (control). BP and LDL-C measurements were performed at 1 month (baseline) and 12 months post-discharge. Intervention group patients who did not meet target values at baseline received additional follow-up, including titration of medication and lifestyle counselling, to reach treatment goals (BP < 140/90 mmHg, LDL-C < 2.5 mmol/L).ResultsAt 12 months, mean systolic BP, diastolic BP and LDL-C was 3.3 (95% CI 0.3 to 6.3) mmHg, 2.3 mmHg (95% CI 0.5 to 4.2) and 0.3 mmol/L (95% CI 0.1 to 0.4) lower in the intervention group compared to controls. Among participants with values above the treatment goal at baseline, the difference in systolic BP and LDL-C was more pronounced (8.0 mmHg, 95% CI 4.0 to 12.1, and 0.6 mmol/L, 95% CI 0.4 to 0.9). A larger proportion of the intervention group reached the treatment goal for systolic BP (68.5 vs. 56.8%, p = 0.008) and LDL-C (69.7% vs. 50.4%, p < 0.001).ConclusionsNurse-led, telephone-based secondary preventive follow-up, including medication adjustment, was significantly more efficient than usual care at improving BP and LDL-C levels by 12 months post-discharge.Trial RegistrationISRCTN Registry ISRCTN23868518
Highlights
Stroke is a major cause of morbidity and mortality worldwide [1] and it is well-established that stroke survivors are at high risk of suffering subsequent vascular events [2,3,4]
At 12 months, mean systolic blood pressure (BP), diastolic BP and low-density lipoprotein cholesterol (LDL-C) was 3.3 mmHg, 2.3 mmHg and 0.3 mmol/L lower in the intervention group compared to controls
In studies in which participant populations are restricted to stroke and transient ischemic attack (TIA) patients, follow-up programs that are mainly led by nurses, as compared to the usual follow-up care have, so far, achieved modest results, mostly without statistical significance, in terms of improved BP and LDL-C levels [12, 14,15,16,17,18,19,20]
Summary
Stroke is a major cause of morbidity and mortality worldwide [1] and it is well-established that stroke survivors are at high risk of suffering subsequent vascular events [2,3,4]. In studies in which participant populations are restricted to stroke and TIA patients, follow-up programs that are mainly led by nurses, as compared to the usual follow-up care have, so far, achieved modest results, mostly without statistical significance, in terms of improved BP and LDL-C levels [12, 14,15,16,17,18,19,20] Most of these studies have, been rather small [12, 14,15,16, 18, 19] and have not included pharmacological titration as part of the intervention [14, 15, 18,19,20]. We investigated whether nurse-led, telephone-based follow-up was more efficient than usual care at improving BP and LDL-C levels at 12 months after hospital discharge
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