Long-term, telephone-based follow-up after stroke and TIA improves risk factors: 36-month results from the randomized controlled NAILED stroke risk factor trial

Joachim Ögren, Anna-Lotta Irewall, Lars Söderström, Thomas Mooe, Joachim Ögren, Anna-Lotta Irewall, Lars Söderström, Thomas Mooe

Abstract

Background: 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). 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.

Methods: All 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.

Results: Out 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).

Conclusions: Compared 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 registration: ISRCTN Registry ISRCTN23868518 (retrospectively registered, June 19, 2012).

Keywords: Blood pressure; Cholesterol; Modifiable risk factors; Nurses; Randomized controlled study; Secondary prevention; Stroke; TIA; Telemedicine.

Conflict of interest statement

Ethics approval and consent to participate

The study was approved by the Regional Ethics Committee, Umeå, on Oct 28, 2009. All participants signed an informed, written consent document.

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Study flow chart. TIA transient ischemic attack, BP blood pressure, LDL-C low-density lipoprotein cholesterol
Fig. 2
Fig. 2
Unadjusted mean values and proportions of participants reaching targets for SBP, DBP, and LDL-C at 1, 12, and 24 months before and after medication titration and at 36 months. BP blood pressure, LDL-C low-density lipoprotein cholesterol, m months
Fig. 3
Fig. 3
Proportion of participants with at least one SBP, DBP, or LDL-C measurement above the treatment target at 1, 12, 24 and 36 months follow up and during the entire study period. m months

References

    1. Feigin VL, Forouzanfar MH, Krishnamurthi R, Mensah GA, Connor M, Bennett DA, Moran AE, Sacco RL, Anderson L, Truelsen T, et al. Global and regional burden of stroke during 1990-2010: findings from the global burden of disease study 2010. Lancet. 2014;383:245–255.
    1. Feng WHR, Adams RJ. Risk of recurrent stroke, myocardial infarction, or death in hospitalized stroke patients. Neurology. 2010;74:588–593.
    1. Mohan KMWC, Rudd AG, Heuschmann PU, Kolominsky-Rabas PL, Grieve AP. Risk and cumulative risk of stroke recurrence: a systematic review and meta-analysis. Stroke. 2011;42:1489–1494.
    1. Touzé EVO, Chatellier G, Peyrard S, Rothwell PM, Mas JL. Risk of myocardial infarction and vascular death after transient ischemic attack and ischemic stroke: a systematic review and meta-analysis. Stroke. 2005;36:2748–2755.
    1. Liu L, Wang Z, Gong L, Zhang Y, Thijs L, Staessen JA, et al. Blood pressure reduction for the secondary prevention of stroke: a chinese trial and a systematic review of the literature. Hypertens Res. 2009;32:1032–1040.
    1. Amarenco PBJ, Callahan A, 3rd, Goldstein LB, Hennerici M, Rudolph AE, Sillesen H, Simunovic L, Szarek M, Welch KM, Zivin JA. Stroke prevention by aggressive reduction in cholesterol levels (SPARCL) investigators. High-dose atorvastatin after stroke or transient ischemic attack NEJM. 2006;355:549–559.
    1. Kernan WN, Ovbiagele B, Black HR, Bravata DM, Chimowitz MI, Ezekowitz MD, Fang MC, Fisher M, Furie KL, Heck DV, et al. Guidelines for the prevention of stroke in patients with stroke and transient ischemic attack: a guideline for healthcare professionals from the american heart association/american stroke association. Stroke. 2014;45:2160–2236.
    1. Piepoli MF, Hoes AW, Agewall S, Albus C, Brotons C, Catapano AL, Cooney MT, Corra U, Cosyns B, Deaton C, et al. 2016 european guidelines on cardiovascular disease prevention in clinical practice: the sixth joint task force of the european society of cardiology and other societies on cardiovascular disease prevention in clinical practice (constituted by representatives of 10 societies and by invited experts)developed with the special contribution of the european association for cardiovascular prevention & rehabilitation (eacpr) Eur Heart J. 2016;37:2315–2381.
    1. Amar JCJ, Touzé E, Bongard V, Jullien G, Vahanian A, Coppé G, Mas JL. ECLAT1 study investigators. Comparison of hypertension management after stroke and myocardial infarction: results from eclat1--a french nationwide study. Stroke. 2004;35:1579–1583.
    1. Brewer L, Mellon L, Hall P, Dolan E, Horgan F, Shelley E, Hickey A, Williams D. Secondary prevention after ischaemic stroke: the aspire-s study. BMC Neurol. 2015;15:216.
    1. Heuschmann PUKJ, Nowe T, Dittrich R, Reiner Z, Cifkova R, Malojcic B, Mayer O, Bruthans J, Wloch-Kopec D, Prugger C, et al. Control of main risk factors after ischaemic stroke across europe: data from the stroke-specific module of the EUROASPIRE III survey. Eur J Prev Cardiol. 2015;22:1354–1362.
    1. Alvarez-Sabin JQM, Hernandez-Presa MA, Alvarez C, Chaves J, Ribo M. Therapeutic interventions and success in risk factor control for secondary prevention of stroke. J Stroke Cerebrovas Dis. 2009;18:460–465.
    1. Jonsson AC, Hoglund P, Brizzi M, Pessah-Rasmussen H. Secondary prevention and health promotion after stroke: can it be enhanced? J Stroke Cerebrovas Dis. 2014;23:2287–2295.
    1. Lager KE, Mistri AK, Khunti K, Haunton VJ, Sett AK, Wilson AD. Interventions for improving modifiable risk factor control in the secondary prevention of stroke. The Cochrane database Syst Rev. 2014:Cd009103.
    1. Ihle-Hansen H, Thommessen B, Fagerland MW, Oksengard AR, Wyller TB, Engedal K, Fure B. Multifactorial vascular risk factor intervention to prevent cognitive impairment after stroke and tia: a 12-month randomized controlled trial. Int J Stroke. 2014;9:932–938.
    1. Kronish IM, Goldfinger JZ, Negron R, Fei K, Tuhrim S, Arniella G, Horowitz CR. Effect of peer education on stroke prevention: the prevent recurrence of all inner-city strokes through education randomized controlled trial. Stroke. 2014;45:3330–3336.
    1. McAlister FA, Majumdar SR, Padwal RS, Fradette M, Thompson A, Buck B, Dean A, Bakal JA, Tsuyuki R, Grover S, et al. Case management for blood pressure and lipid level control after minor stroke: prevention randomized controlled trial. CMAJ. 2014;186:577–584.
    1. O'Carroll RE, Chambers JA, Dennis M, Sudlow C, Johnston M. Improving medication adherence in stroke survivors: mediators and moderators of treatment effects. Health Psychol. 2014;33:1241–1250.
    1. Glynn LG, Murphy AW, Smith SM, Schroeder K, Fahey T. Interventions used to improve control of blood pressure in patients with hypertension. Cochrane database Syst Rev. 2010:Cd005182.
    1. Irewall ALÖJ, Bergström L, Laurell K, Söderström L, Mooe T. Nurse-led, telephone-based, secondary preventive follow-up after stroke or transient ischemic attack improves blood pressure and ldl cholesterol: results from the first 12 months of the randomized, controlled nailed stroke risk factor trial. PLoS One. 2015;10:e0139997.
    1. Joubert J, Reid C, Barton D, Cumming T, McLean A, Joubert L, Barlow J, Ames D, Davis S. Integrated care improves risk-factor modification after stroke: initial results of the integrated care for the reduction of secondary stroke model. J Neurol Neurosurg Psychiatry. 2009;80:279–284.
    1. Kraft P, Hillmann S, Rucker V, Heuschmann PU. Telemedical strategies for the improvement of secondary prevention in patients with cerebrovascular events-a systematic review and meta-analysis. Int J Stroke. 2017;12:597–605.
    1. Brotons C, Soriano N, Moral I, Rodrigo MP, Kloppe P, Rodriguez AI, Gonzalez ML, Arino D, Orozco D, Buitrago F, et al. Randomized clinical trial to assess the efficacy of a comprehensive programme of secondary prevention of cardiovascular disease in general practice: the preseap study. Revista espanola de cardiologia. 2011;64:13–20.
    1. Oral Abstracts. European Stroke Journal. 2017;2(IS)3–97 10.1177/2396987317705236
    1. Mooe TBL, Irewall A-L, Ögren J. The nailed stroke risk factor trial (nurse based age independent intervention to limit evolution of disease after stroke): Study protocol for a randomized controlled trial. Trials. 2013;14:5.
    1. Law MR, Morris JK, Wald NJ. Use of blood pressure lowering drugs in the prevention of cardiovascular disease: meta-analysis of 147 randomised trials in the context of expectations from prospective epidemiological studies. BMJ. 2009;338:b1665.
    1. Snaterse M, Dobber J, Jepma P, Peters RJ, Ter Riet G, Boekholdt SM, et al. Effective components of nurse-coordinated care to prevent recurrent coronary events: a systematic review and meta-analysis. Heart. 2016;102:50–56.
    1. collaboration TR. Riksstroke annual report 2014; stroke and tia. 2015.
    1. Roumie CL, Zillich AJ, Bravata DM, Jaynes HA, Myers LJ, Yoder J, Cheng EM. Hypertension treatment intensification among stroke survivors with uncontrolled blood pressure. Stroke. 2015;46:465–470.
    1. Group PC. Randomised trial of a perindopril-based blood-pressure-lowering regimen among 6,105 individuals with previous stroke or transient ischaemic attack. Lancet. 2001;358:1033–1041.
    1. Welin L, Bjalkefur K, Roland I. Open, randomized pilot study after first stroke: a 3.5-year follow-up. Stroke. 2010;41:1555–1557.
    1. Irewall AL, Bergstrom L, Ogren J, Laurell K, Soderstrom L, Mooe T. Implementation of telephone-based secondary preventive intervention after stroke and transient ischemic attack - participation rate, reasons for nonparticipation and one-year mortality. Cerebrovasc Dis extra. 2014;4:28–39.

Source: PubMed

스폰서 및 공동 작업자

건강 상태

약물 개입

3
구독하다