Telehealth After Stroke Care Pilot Randomized Trial of Home Blood Pressure Telemonitoring in an Underserved Setting

Imama A Naqvi, Kevin Strobino, Ying Kuen Cheung, Hanlin Li, Kevin Schmitt, Stephen Ferrara, Sarah E Tom, Adriana Arcia, Olajide A Williams, Ian M Kronish, Mitchell S V Elkind, Imama A Naqvi, Kevin Strobino, Ying Kuen Cheung, Hanlin Li, Kevin Schmitt, Stephen Ferrara, Sarah E Tom, Adriana Arcia, Olajide A Williams, Ian M Kronish, Mitchell S V Elkind

Abstract

Background: Hypertension is the most important modifiable stroke risk factor, but blood pressure (BP) remains poorly controlled after stroke, especially among Black and Hispanic patients. We tested the feasibility of TASC (Telehealth After Stroke Care), a post-acute stroke care model integrating nurse-supported home BP telemonitoring, tailored infographics, and multidisciplinary team video visits.

Methods: Acute stroke patients with hypertension were randomized at discharge to usual care or usual care with TASC. Usual care patients received video visits with primary care and stroke. TASC included a tablet and monitor to wirelessly transmit BP data to the electronic health record, with telenursing support, tailored infographics to explain BP readings, and pharmacist visits. Outcomes assessment was blinded. Feasibility outcomes included recruitment, randomization, adherence, and retention. Systolic BP from baseline to 3 months after discharge was evaluated using generalized linear modeling.

Results: Fifty patients (64±14 years; 36% women' 44% Hispanic, 32% Black, 54% ≤high school education, 30% private insurance), and 75% of all eligible were enrolled over 6.3 months. Baseline systolic BP was similar in both (TASC n=25, 140±19 mm Hg; usual care n=25, 142±19 mm Hg). At 3 months, adherence to video visits (91% versus 75%, P=0.14) and retention (84% versus 64%, P=0.11) were higher with TASC. Home systolic BP declined by 16±19 mm Hg from baseline in TASC and increased by 3±24 mm Hg in usual care (P=0.01). Among Black patients, systolic BP control (<130 mm Hg) improved from 40% to 100% with TASC versus 14% to 29%, and among Hispanic patients, from 23% to 62% with TASC, versus 33% to 17% in usual care.

Conclusions: Enhancing post-acute stroke care with home BP telemonitoring is feasible to improve hypertension in an underserved setting and should be tested in a definitive randomized clinical trial.

Registration: URL: https://www.

Clinicaltrials: gov; Unique identifier: NCT04640519.

Keywords: disparities; hypertension; multidisciplinary; self-efficacy; stroke; telehealth.

Figures

Figure 1.
Figure 1.
CONSORT (Consolidated Standards of Reporting Trials) flow diagram. BP indicates blood pressure; and TIA, transient ischemic attack.
Figure 2.
Figure 2.
Outcome of change in home systolic blood pressure over study period. Each dot represents an individual. Baseline to 3-mo reduction in systolic blood pressure in the study intervention arm, and a slight increase among the study usual care arm.

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