Abstract TMP87: The Efficacy of a Chronic Care Based Intervention on Secondary Stroke Prevention Among Vulnerable Stroke Survivors: A Randomized, Controlled Trial

Abstract

Background: Effective interventions to improve stroke preventative care in vulnerable populations have not been reported. Methods: We tested the impact of a chronic care model-based intervention program among 407 subjects with a recent stroke or transient ischemic attack at four Los Angeles County public hospitals. All subjects had a baseline systolic blood pressure (SBP) of at least 120 mm Hg and were randomized after baseline assessment in a 1:1 ratio to usual care or intervention, stratified by hospital and by English/Spanish language. The care management intervention was led by bilingual nurse practitioners or physician assistants, and it consisted of group clinics, self-management support, report cards, decision support, and coordination of ongoing care. Intention-to-treat analyses were conducted using repeated-measures mixed-effects models. The primary outcome was change in SBP. Secondary outcomes were other measures of SBP, low-density lipoprotein (LDL), ACC/AHA 10-year cardiovascular risk, adherence to antihypertensive and to antithrombotic medications, and physical activity. Results: Mean age was 57 years, 60% were male, 18% were African-American race, and 69% were Hispanic ethnicity. 48% had not graduated from high school. Baseline SBP was 150 mm Hg in the usual care arm and 149 mm Hg in the intervention arm. 12 month data were obtained in 333 participants (82%). There were substantial declines in SBP in both the usual care and intervention arms (Table). However, there were no significant differences between the two arms in either improvement of SBP from baseline or other measures of stroke risk factor control. Subgroup analyses did not reveal a differential impact of the intervention by race/ethnicity. Conclusion: Our care management intervention did not improve stroke risk factor control beyond what was attained in usual care. Further analyses are ongoing, and those findings will be used to guide modification of the intervention for future testing.

Stroke Disparities: From Observations to Actions

“…77 Another research program by this same group was entitled "Systemic Use of Stroke Averting Interventions (SUSTAIN)." 79 They used a community-based approach including group clinics to get stroke and TIA survivors to improve their risk factor control. At 12 months, systolic pressure was only slightly better in the intervention group compared to usual care, but low-density lipoprotein levels were significantly lower.…”

Lobar intracerebral hemorrhage and risk of subsequent uncontrolled blood pressure

“…7,[9][10][11] Additionally, clinical trials of BP control interventions in stroke survivors have persistently failed to improve BP control. 12,13 Therefore, gaining better insight into the determinants of better BP control after ICH is critical to developing targeted therapeutic strategies that could effectively preserve brain health in survivors of ICH.…”