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

Background: Effective 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. Methods: Two 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. Results: 168 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). Conclusions: Risk 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

Baseline demographics and risk factors in both cohorts (patients attending 6-month follow-up).

*<p>observational patients willing to participate in a future support program.</p>**<p>without DWI lesion in MRI.</p

Diastolic blood pressure measured during observation period.

<p>Diastolic blood pressure measured during observation period.</p

Baseline demographics and risk factors of observational cohort (patients attending 6-month follow-up, A: willing to participate in a support program, B: not willing to participate in a support program).

*<p>without DWI lesion in MRI.</p

Systolic blood pressure measured during observation period.

<p>Systolic blood pressure measured during observation period.</p

Study flow chart.

<p>Study flow chart.</p

6 month follow-up data (blood pressure values, target values and vascular re-events) in both cohorts.

*<p>LDL available in 140 patients of the observational cohort and in 164 patients of the supported cohort.</p>**<p>In the observational group 25/50 patients (50%) and in the support program 26/33 (79%) quit smoking (p<0.01).</p>***<p>Number of patients with AF and documented treatment regarding oral anticoagulation was 54 in the observational cohort and 27 in the support program.</p>****<p>Number of patients with AF and INR-measurements at six month was 44 in the observational cohort and 26 in den support program.</p