Telehealth After Stroke Care Pilot Randomized Trial of Home Blood Pressure Telemonitoring in an Underserved Setting

Abstract

Background: Hypertension is the most important modifiable stroke risk factor, but blood pressure (BP) remains poorly controlled after stroke, especially among Black and Hispanic patients. We tested the feasibility of TASC (Telehealth After Stroke Care), a post-acute stroke care model integrating nurse-supported home BP telemonitoring, tailored infographics, and multidisciplinary team video visits. Methods: Acute stroke patients with hypertension were randomized at discharge to usual care or usual care with TASC. Usual care patients received video visits with primary care and stroke. TASC included a tablet and monitor to wirelessly transmit BP data to the electronic health record, with telenursing support, tailored infographics to explain BP readings, and pharmacist visits. Outcomes assessment was blinded. Feasibility outcomes included recruitment, randomization, adherence, and retention. Systolic BP from baseline to 3 months after discharge was evaluated using generalized linear modeling. Results: Fifty patients (64±14 years; 36% women‚ 44% Hispanic, 32% Black, 54% ≤high school education, 30% private insurance), and 75% of all eligible were enrolled over 6.3 months. Baseline systolic BP was similar in both (TASC n=25, 140±19 mm Hg; usual care n=25, 142±19 mm Hg). At 3 months, adherence to video visits (91% versus 75%, P =0.14) and retention (84% versus 64%, P =0.11) were higher with TASC. Home systolic BP declined by 16±19 mm Hg from baseline in TASC and increased by 3±24 mm Hg in usual care ( P =0.01). Among Black patients, systolic BP control (<130 mm Hg) improved from 40% to 100% with TASC versus 14% to 29%, and among Hispanic patients, from 23% to 62% with TASC, versus 33% to 17% in usual care. Conclusions: Enhancing post-acute stroke care with home BP telemonitoring is feasible to improve hypertension in an underserved setting and should be tested in a definitive randomized clinical trial. Registration: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT04640519.

A Scoping Review of mHealth Interventions for Secondary Prevention of Stroke: Implications for Policy and Practice

“…Overall, 17 publications (2%) were retained as meeting the inclusion criteria (Figure), including 13 RCTs, and 4 qualitative, mixedmethods, or process evaluations. This review included 8 pilot RCTs, [23][24][25][26][27][28][29][30] and 5 phase III RCTs (Table 1), [31][32][33][34][35] comprising 6747 participants, with 8 (62%) having <70 participants. Only 2 RCTs were limited to people with ischemic stroke, and only 1 included participants with transient ischemic attack (TIA).…”

“…24,25,27,28,30 Support and guidance from clinicians was an intervention component in 7 RCTs, 24,25,27,28,32,34,35 either delivered face-to-face (3/13), 24,32,35 or by telephone or video calls (4/13). 25,27,28,34 Clinical support included guidance through the intervention from a physical therapist (1/13) 24 and follow-up appointments with a pharmacist, nurse, doctor, or physician (6/13). 25,27,28,32,34,35…”

“…25,27,28,34 Clinical support included guidance through the intervention from a physical therapist (1/13) 24 and follow-up appointments with a pharmacist, nurse, doctor, or physician (6/13). 25,27,28,32,34,35…”

“…As shown in Table 1, the primary outcome in 4 pilot RCTs was feasibility of the intervention, measured by retention/completion (4/4), 23,25,27,28 participant recruitment (2/4), 27,28 and program adherence (1/4). 28 In all 4 RCTs, retention in the intervention arm was >80%, generally comparable to the control arm. 23,25,27,28 Only 1 RCT exploring recruitment reached a prespecified target, as well as satisfactory adherence (90%).…”

Telehealth Trials to Address Health Equity in Stroke Survivors

“…75 Finally, a recently published pilot trial of telehealth with remote BP monitoring in an underserved population in New York demonstrated potential for impact on BP control in stroke survivors. 76…”