Mitigating the effects of COVID-19 pandemic on controlling vascular risk factors among participants in a carotid stenosis trial

Abstract

Introduction: The COVID-19 pandemic has presented challenges to managing vascular risk factors with in-person follow-up of patients with asymptomatic carotid stenosis enrolled in the CREST2 trial. CREST2 is comparing intensive medical management alone versus intensive medical management plus revascularization with endarterectomy or stenting. We performed a study to evaluate the feasibility of a home-based program for testing blood pressure (BP) and low-density lipoprotein (LDL) in CREST2. Methods: This study involved 45 patients at 10 sites in the CREST2 trial. The initial patients were identified by the Medical Management Core (MMC) as high-risk patients defined by stage 2 hypertension, LDL > 90 mg/dl, or both. If a patient at the site declined participation, another was substituted. All patients who agreed to participate were sent a BP monitoring device and a commercially available at-home lipid test kit that uses a self-performed finger-stick blood sample that was resulted to the patient. Training on the use of the equipment and obtaining the risk factor results was done by the study coordinator by telephone. Results: Ten of the 130 currently active CREST2 sites participated, 8 in the LDL portion and 5 in the BP portion (3 sites did both). Twenty-six BP devices and 23 lipid tests were sent to patients. Of the 26 patients who obtained BP readings with the devices, 9 were out of the study target and adjustments in BP medications were made in 3. Of the 23 patients sent LDL tests, 13 were able to perform the test showing 7 were out of target, leading to adjustments in lipid medications in 4. Conclusion: This study established the feasibility of at-home monitoring of BP and LDL in a clinical trial and identified implementation challenges prior to widespread use in the trial.

Vascular Surgery and Neurosurgery

“…Stroke and myocardial infarction are common complications of coronavirus disease 2019 (COVID-19) in the frail and elderly. Recruitment in non-COVID trials has been halted, 5 and in CREST-2 (Carotid Revascularisation Endarterectomy Versus Stenting Trial 2) staff were furloughed; to ensure continuity, patients measured their own blood pressure and lipid levels using devices purchased by the study organizers. Fortunately, CREST-2 continues to recruit and may reach its target of 2480 patients during 2022.…”