Utility of a Physician Directed, Nurse Based Stroke Prevention Program (P07.022)

Abstract

Objective: To determine if a physician directed, nurse based program could improve at least 1 major risk factor to goal in patients with atherosclerotic stroke at 1 year compared to usual care. Background Evidence based guidelines exist for the prevention and treatment of patients with cerebral ischemia. Despite these guidelines, there are gaps in clinical practice. Design/Methods: Patients with atherosclerotic stroke were eligible. Patients had at least one major (hypertension, diabetes, smoking, dyslipidemia) risk factor not at goal to participate. Patients were randomized to a nurse case management system versus usual care. The nurses involved were trained in stroke risk factors and motivational interviewing. Nurses followed algorithms for each risk factor and developed action plans for individual patients. Patients in the nurse group also received dietary consultation and an exercise prescription. Patients were seen in person by nurses at baseline, 6 weeks, 6 months and 1 year. Patients received phone calls at 3 months and 9 months. Patients in both groups were followed for 1 year. The primary endpoint was improvement of 1 major risk factor at 1 year. Results: Twenty patients were randomized to the nurse program and 21 patients to usual care. After 1 year, 61% of patients in the nurse program and 33% of patients in the usual care improved at least 1 major risk factor (P=0.09). Patients in the prevention group were more likely to follow a prescribed diet (50% vs 7%, p=0.0018) and maintain an exercise program (83% vs. 33%, p=0.0018). In addition, patients in the prevention group had greater changes in the systolic blood pressure and LDL compared to usual care. Conclusions: A physician directed, nurse case management system is feasible and may help improve achievement of major risk factors. A larger randomized trial is helpful to verify trends noted in this study. Supported by: American Heart Association. Disclosure: Dr. Flemming has nothing to disclose. Dr. Brown has nothing to disclose.