Secondary prevention after minor stroke and TIA - usual care and development of a support program

Stefanie Leistner, Steffen Benik, Inga Laumeier, Annerose Ziegler, Gabriele Nieweler, Christian H Nolte, Peter U Heuschmann, Heinrich J Audebert, Stefanie Leistner, Steffen Benik, Inga Laumeier, Annerose Ziegler, Gabriele Nieweler, Christian H Nolte, Peter U Heuschmann, Heinrich J Audebert

Abstract

Background: Effective methods of secondary prevention after stroke or TIA are available but adherence to recommended evidence-based treatments is often poor. The study aimed to determine the quality of secondary prevention in usual care and to develop a stepwise modeled support program.

Methods: Two consecutive cohorts of patients with acute minor stroke or TIA undergoing usual outpatient care versus a secondary prevention program were compared. Risk factor control and medication adherence were assessed in 6-month follow-ups (6M-FU). Usual care consisted of detailed information concerning vascular risk factor targets given at discharge and regular outpatient care by primary care physicians. The stepwise modeled support program additionally employed up to four outpatient appointments. A combination of educational and behavioral strategies was employed.

Results: 168 patients in the observational cohort who stated their openness to participate in a prevention program (mean age 64.7 y, admission blood pressure (BP): 155/84 mmHg) and 173 patients participating in the support program (mean age 67.6 y, BP: 161/84 mmHg) were assessed at 6 months. Proportions of patients with BP according to guidelines were 50% in usual-care and 77% in the support program (p<0.01). LDL<100 mg/dl was measured in 62 versus 71% (p = 0.12). Proportions of patients who stopped smoking were 50 versus 79% (p<0.01). 72 versus 89% of patients with atrial fibrillation were on oral anticoagulation (p = 0.09).

Conclusions: Risk factor control remains unsatisfactory in usual care. Targets of secondary prevention were met more often within the supported cohort. Effects on (cerebro-)vascular recurrence rates are going to be assessed in a multicenter randomized trial.

Trial registration: ClinicalTrials.gov NCT01586702.

Conflict of interest statement

Competing Interests: HJA has received speaker honoraria from Lundbeck Pharma, Boehringer Ingelheim Pharma, Takeda Pharma, Sanofi Synthelabo, Bayer Vital, UCB Pharma as well as consultancy honoraria from Lundbeck Pharam and Bayer Vital. There are no conflicts of interest regarding employment, consultancy, patents, products in development or marketed products etc. in relation to any commercial funder. The above mentioned potential conflicts of interest do not alter the authors' adherence to all the PLOS ONE policies on sharing data and materials.

Figures

Figure 1. Study flow chart.
Figure 1. Study flow chart.
Figure 2. Systolic blood pressure measured during…
Figure 2. Systolic blood pressure measured during observation period.
Figure 3. Diastolic blood pressure measured during…
Figure 3. Diastolic blood pressure measured during observation period.

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