STROKE-CARD care to prevent cardiovascular events and improve quality of life after acute ischaemic stroke or TIA: A randomised clinical trial

Willeit, Peter; Toell, Thomas; Boehme, Christian; Krebs, Stefan; Mayer, Lukas; Lang, Clemens; Seekircher, Lisa; Tschiderer, Lena; Willeit, Karin; Rumpold, Gerhard; Schoenherr, Gudrun; Griesmacher, Andrea; Ferrari, Julia; Knoflach, Michael; Lang, Wilfried; Kiechl, Stefan; Willeit, Johann

doi:10.1016/j.eclinm.2020.100476

Cited by 44 publications

(72 citation statements)

References 29 publications

(37 reference statements)

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“…This study reduced recurrent vascular events and improved QoL (co-primary endpoints) as well as functional outcome (secondary endpoint) at 12 months. 11 However, it did not improve 12-month risk factor profiles compared with the control group, yet risk factor control was overall better than in real-world surveys from Europe. 12 Studies with a primary focus on risk factors A majority of studies had their key focus on risk factor control which served as the primary study outcome.…”

Section: Large Multifaceted Rctsmentioning

confidence: 81%

Longer term patient management following stroke: A systematic review

Boehme

Toell

Lang

et al. 2021

International Journal of Stroke

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Background Tremendous progress in acute stroke therapy has improved short-term outcome but part of this achievement may be lost in the long run. Concepts for a better long-term management of stroke survivors are needed to address their unmet needs and to reduce the burden of post-stroke complications, residual deficits and recurrent vascular events. Aims This review summarizes current knowledge on post-hospital care and the scientific evidence supporting individual programs. Summary of review A systematic search of electronic databases according to PRISMA guidelines identified 10,374 articles, 77 of which met the inclusion criteria. One large randomised controlled trial on a multifaceted care program delivered by the multidisciplinary stroke team reduced recurrent vascular events and improved quality of life and functional outcome one year after the event while a number of studies offer solutions for individual components of post-hospital disease management like patient education, counselling, and self-management or the management of post-stroke complications and residual deficits. A majority of studies, however, was small in size and limited by a short follow-up. Most initiatives with a narrow focus on risk factor control failed to lower the risk of recurrent events. The caregiversâ central role in post-stroke patient management is broadly neglected in research. Conclusions Over the past years, first knowledge on how to best organize post-hospital care of stroke patients has emerged. Comprehensive and pragmatic programs operated by the multidisciplinary stroke team hold promise to reduce the long-term health burden of stroke. There is a clear need for further high-quality studies with both clinical endpoints and patient-reported outcomes to establish sustainable solutions in different settings and regions to improve life after stroke, a key priority of the Stroke Action Plan for Europe 2018-2030.

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Section: Large Multifaceted Rctsmentioning

confidence: 81%

Longer term patient management following stroke: A systematic review

Boehme

Toell

Lang

et al. 2021

International Journal of Stroke

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“…There is recent evidence for a similar comprehensive stroke follow-up program to reduce cardiovascular risk and improve quality of life at one year post-stroke. 17 This study adds a detailed quantification of stroke-related health problems and the resource use of prompted interventions.…”

Section: Our Research In Context Of Current Knowledgementioning

confidence: 99%

“…A comprehensive program aimed at treating both vascular risk factors and other stroke-related health problems may therefore be more effective than narrower approaches, which has been shown for the first time in the STROKE-CARD study. 7 In 2013, the Post-stroke Checklist (PSC) was developed by an international group of stroke experts. 8 The original PSC consists of eleven questions concerning common and treatable post-stroke problems affecting quality of life.…”

Section: Introductionmentioning

confidence: 99%

Comprehensive and Structured 3-month Stroke Follow-up Using the Post-stroke Checklist (The Struct-FU study): A Feasibility and Explorative Study

Ullberg

Månsson

Berhin

et al. 2021

Journal of Stroke and Cerebrovascular Diseases

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Background: There is recent evidence supporting that a comprehensive post-stroke treatment program improves outcome. However, the prevalence of stroke-related health problems and the extent of needed interventions have not been well-delineated. The Struct-FU study aims to assess the feasibility of a comprehensive stroke follow-up model and to map stroke-related problems and subsequent multidisciplinary interventions using a modified Post-stroke Checklist (PSC). Methods: We consecutively screened all acute stroke patients at Ska ne University Hospital, Sweden during an eight-month period in 2018À2019. Patients discharged to own home were eligible for inclusion. We defined a stroke-related health problem as a health-or social issue corresponding to one of the 14 items in the modified PSC, and with onset after the stroke event. Three-months post-stroke, a semi-structured interview using a 14-item modified PSC was completed to map the prevalence of stroke-related health problems, as well as any subsequent multidisciplinary stroke team interventions prompted by the visit. Results: The number of included patients was 200. Of these, 165 (82.9%) completed three-month follow-up, one died, and 34 were lost to follow-up. All patients completed the full PSC, and the majority (92.7%) reported stroke-related problems identified using the PSC, with the median number being three per patient, and half having four or more problems. Patients <=65 years (n=44) presented with more stroke-related problems than patients >65 years (n=121) (5 vs. 3, p=0.003). The median number of interventions was two per patient. Doctor's interventions (changes in medication, referrals or further work-up) were done in 53% of patients, 77% needed a nurse's or other stroke team professional's intervention (tailored advice, information, audits, rehabilitation assessments) and 15% needed no intervention. Only 3.6% of patients reported other stroke-related challenges (PSC item 14) than those specified in item 1À13. Conclusion: We report a high burden of stroke-related health problems in community dwelling stroke patients with mild to moderate stroke. Multidisciplinary interventions were prompted in the vast majority (85%). Only 3.6% of patients reported challenges not captured with the Post-stroke Checklist, reflecting that the comprehensive approach captures the majority of stroke-related health problems, and gives a good estimate of the total stroke-related health burden for each individual.

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“…While these approaches include interventions targeted at reducing modifiable cardiovascular risk factors such as arterial hypertension and physical inactivity [ 4 ], individuals with higher cardiac risk frequently do not meet secondary prevention guidelines [ 5 ]. Early rehabilitative needs post TIA or minor stroke can also be complex [ 6 , 7 ], meaning it is uncertain how to best implement secondary preventative approaches in these populations.…”

Section: Introductionmentioning

confidence: 99%

Development of a Digital Lifestyle Modification Intervention for Use after Transient Ischaemic Attack or Minor Stroke: A Person-Based Approach

Heron

O’Connor

Kee

et al. 2021

IJERPH

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This paper describes the development of the ‘Brain-Fit’ app, a digital secondary prevention intervention designed for use in the early phase after transient ischaemic attack (TIA) or minor stroke. The aim of the study was to explore perceptions on usability and relevance of the app in order to maximise user engagement and sustainability. Using the theory- and evidence-informed person-based approach, initial planning included a scoping review of qualitative evidence to identify barriers and facilitators to use of digital interventions in people with cardiovascular conditions and two focus groups exploring experiences and support needs of people (N = 32) with a history of TIA or minor stroke. The scoping review and focus group data were analysed thematically and findings were used to produce guiding principles, a behavioural analysis and explanatory logic model for the intervention. Optimisation included an additional focus group (N = 12) and individual think-aloud interviews (N = 8) to explore perspectives on content and usability of a prototype app. Overall, thematic analysis highlighted uncertainty about increasing physical activity and concerns that fatigue might limit participation. Realistic goals and progressive increases in activity were seen as important to improving self-confidence and personal control. The app was seen as a useful and flexible resource. Participant feedback from the optimisation phase was used to make modifications to the app to maximise engagement, including simplification of the goal setting and daily data entry sections. Further studies are required to examine efficacy and cost-effectiveness of this novel digital intervention.

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STROKE-CARD care to prevent cardiovascular events and improve quality of life after acute ischaemic stroke or TIA: A randomised clinical trial

Cited by 44 publications

References 29 publications

Longer term patient management following stroke: A systematic review

Longer term patient management following stroke: A systematic review

Comprehensive and Structured 3-month Stroke Follow-up Using the Post-stroke Checklist (The Struct-FU study): A Feasibility and Explorative Study

Development of a Digital Lifestyle Modification Intervention for Use after Transient Ischaemic Attack or Minor Stroke: A Person-Based Approach

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