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Intensified secondary prevention program may help control risk factors in stroke

An intensified support program in addition to conventional care for patients with transient ischemic attack or minor stroke was more successful in achieving secondary prevention targets than conventional care alone.

However, the program did not affect the primary outcome of new vascular events.

Researchers reported that at 1 year, compared with those who had conventional care alone, patients with TIA or minor stroke who underwent the support program in combination with conventional care had improvements in risk factors including:

  • BP less than 140/85 mm Hg (59% vs. 48%; P < .001);
  • LDL within target (62% vs. 54%; P = .001);
  • oral anticoagulation on target in patients with atrial fibrillation (83% vs. 75%; P < .055); HbA1c at least 7.5% in patients with diabetes (80% vs. 71%; P < .04);
  • smoking cessation (50% vs. 45%; P = .001); and
  • physical activity (at least three 30-minute sessions per week, 33% vs. 19%; P < .001).

According to the presentation at the International Stroke Conference, the improved support program was applied at eight outpatient facilities during a period of 2 years and featured interventions such as patient empowerment based on motivational interviewing; repeated information on pathophysiology and individual risk for recurrent vascular events and risk reduction; an analysis of risk factor control and medication intake; feedback regarding improvement status and understanding of target plans; and complementary offers such as information on group therapies for physical activity and smoking cessation.

There were no differences between the groups in new vascular events including stroke, ACS and vascular death (HR = 0.92; 95% CI, 0.75-1.14).

“Our conclusions are that the intensified secondary prevention program in patients with minor stroke or TIA improved the achievement of secondary prevention targets, but did not translate to a significantly lower rates rate of major vascular events,” Heinrich Audebert, MD, professor in the department of neurology and Center for Stroke Research at Charité Universitätsmedizin, Berlin, said during the presentation. “It may, however, have positive effects beyond recurrent risk reduction.”

In other findings, patients who underwent the intensified support program also improved in physical fitness as measured by the stair climbing test (P = .038) at 3 years compared with conventional care.

Functional independence as measured by the modified Rankin Scale favored the support program group at 1 year (P = .028), but there was no difference between the groups at 3 years (P = .241), according to the researchers.

However, patients in the support program group did not experience improvement regarding depressive symptoms (P = .79) or cognitive abilities as measured by the Montreal Cognitive Assessment at 3 years (P = .12), although the support group had more people with a normal Montreal Cognitive Assessment score at 3 years compared with controls (62% vs. 60%; P = .037).

For the analysis, researchers included adults with minor stroke or TIA within 14 days of randomization, at least one treatable vascular risk factor and the ability to attend outpatient visits.

“These are patient-reported outcomes, so neither the patients nor the study nurses that assessed these outcomes were blinded to the intervention,” Audebert said during the presentation. “The follow-up was not complete, as we could only assess patients who attended the follow-up visits and we did no adjustment for multiple testing. So be careful in interpreting these P values.” – by Scott Buzby

Reference:

Audebert HJ, et al. LB7. Presented at: International Stroke Conference; Feb. 19-21, 2020; Los Angeles.

Disclosures: Audebert reports he received honoraria from Bayer Healthcare, Boehringer Ingelheim, Bristol-Myers Squibb, Pfizer and Takeda; is a consultant for Bayer Healthcare, Bristol-Myers Squibb, Novo Nordisk and Pfizer; and received research support from Pfizer.

An intensified support program in addition to conventional care for patients with transient ischemic attack or minor stroke was more successful in achieving secondary prevention targets than conventional care alone.

However, the program did not affect the primary outcome of new vascular events.

Researchers reported that at 1 year, compared with those who had conventional care alone, patients with TIA or minor stroke who underwent the support program in combination with conventional care had improvements in risk factors including:

  • BP less than 140/85 mm Hg (59% vs. 48%; P < .001);
  • LDL within target (62% vs. 54%; P = .001);
  • oral anticoagulation on target in patients with atrial fibrillation (83% vs. 75%; P < .055); HbA1c at least 7.5% in patients with diabetes (80% vs. 71%; P < .04);
  • smoking cessation (50% vs. 45%; P = .001); and
  • physical activity (at least three 30-minute sessions per week, 33% vs. 19%; P < .001).

According to the presentation at the International Stroke Conference, the improved support program was applied at eight outpatient facilities during a period of 2 years and featured interventions such as patient empowerment based on motivational interviewing; repeated information on pathophysiology and individual risk for recurrent vascular events and risk reduction; an analysis of risk factor control and medication intake; feedback regarding improvement status and understanding of target plans; and complementary offers such as information on group therapies for physical activity and smoking cessation.

There were no differences between the groups in new vascular events including stroke, ACS and vascular death (HR = 0.92; 95% CI, 0.75-1.14).

“Our conclusions are that the intensified secondary prevention program in patients with minor stroke or TIA improved the achievement of secondary prevention targets, but did not translate to a significantly lower rates rate of major vascular events,” Heinrich Audebert, MD, professor in the department of neurology and Center for Stroke Research at Charité Universitätsmedizin, Berlin, said during the presentation. “It may, however, have positive effects beyond recurrent risk reduction.”

In other findings, patients who underwent the intensified support program also improved in physical fitness as measured by the stair climbing test (P = .038) at 3 years compared with conventional care.

Functional independence as measured by the modified Rankin Scale favored the support program group at 1 year (P = .028), but there was no difference between the groups at 3 years (P = .241), according to the researchers.

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However, patients in the support program group did not experience improvement regarding depressive symptoms (P = .79) or cognitive abilities as measured by the Montreal Cognitive Assessment at 3 years (P = .12), although the support group had more people with a normal Montreal Cognitive Assessment score at 3 years compared with controls (62% vs. 60%; P = .037).

For the analysis, researchers included adults with minor stroke or TIA within 14 days of randomization, at least one treatable vascular risk factor and the ability to attend outpatient visits.

“These are patient-reported outcomes, so neither the patients nor the study nurses that assessed these outcomes were blinded to the intervention,” Audebert said during the presentation. “The follow-up was not complete, as we could only assess patients who attended the follow-up visits and we did no adjustment for multiple testing. So be careful in interpreting these P values.” – by Scott Buzby

Reference:

Audebert HJ, et al. LB7. Presented at: International Stroke Conference; Feb. 19-21, 2020; Los Angeles.

Disclosures: Audebert reports he received honoraria from Bayer Healthcare, Boehringer Ingelheim, Bristol-Myers Squibb, Pfizer and Takeda; is a consultant for Bayer Healthcare, Bristol-Myers Squibb, Novo Nordisk and Pfizer; and received research support from Pfizer.

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