Secondary Prevention after Minor Stroke and TIA - Usual Care and Development of a Support Program

Abstract

BackgroundEffective 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.MethodsTwo 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.Results168 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).ConclusionsRisk 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.

Secondary prevention and lifestyle indices after stroke in a long-term perspective

“…The importance of hypertension control to prevent recurrent stroke and cardiac events has been emphasized, 23 and specific programs may improve the results of several aspects of secondary prevention. 24 However, frail older persons may not tolerate blood pressure lowering treatment to the same level as the healthier elderly or younger persons, and consequently, frail elderly need individual assessment of treatment strategies. 25 The prevalence of diabetes mellitus increased from 14%…”

Secondary prevention lifestyle interventions initiated within 90 days after TIA or ‘minor’ stroke: a systematic review and meta-analysis of rehabilitation programmes

“…Similarly, Kirk and colleagues17 found that community-based cardiac rehabilitation programmes for 12 patients post-TIA and minor stroke can be effective at reducing modifiable vascular risk factors. Reviews identifying effective components of rehabilitation following the diagnosis of a TIA and ‘minor’ stroke have begun to emerge,10 – 12 , 31 but, to the authors’ knowledge, this is the first systematic review of the use of comprehensive rehabilitation programmes in the acute period (within 90 days) of the diagnosis of a TIA or ‘minor’ stroke.…”

“…Some current guidelines8 , 9 advocate the promotion of early non-pharmacological secondary prevention after all cerebrovascular events but lack detail regarding effective methods of its delivery. There have been reports of lifestyle interventions post-TIA and minor stroke 10 – 12. However, the authors have not identified any previous systematic reviews of the evidence relating to the effectiveness of early post-TIA rehabilitation or secondary prevention programmes that describe lifestyle interventions.…”

The stroke east Saxony pilot project for organized post‐stroke care: a case–control study

“…2011; Leistner et al. 2012). Lastly, levels of patients’ satisfaction and quality of life – both increasingly recognized as important patient‐reported outcomes in acute stroke trials – were significantly higher in those receiving organized post‐stroke than usual care and therefore may have contributed to overall sufficient risk factor control in our study patients as previously suggested by the AVAIL registry (Bushnell et al.…”