Abstract TMP87: The Efficacy of a Chronic Care Based Intervention on Secondary Stroke Prevention Among Vulnerable Stroke Survivors: A Randomized, Controlled Trial

Stroke ◽  
2016 ◽  
Vol 47 (suppl_1) ◽  
Author(s):  
Eric M Cheng ◽  
William E Cunningham ◽  
Amytis Towfighi ◽  
Nerses Sanossian ◽  
Robert J Bryg ◽  
...  
Keyword(s):  
Risk Factor ◽  
Usual Care ◽  
Care Management ◽  
Chronic Care ◽  
Stroke Risk ◽  
Public Hospitals ◽  
Risk Factor Control ◽  
Stroke Risk Factor ◽  
Management Intervention ◽  
The Impact

Background: Effective interventions to improve stroke preventative care in vulnerable populations have not been reported. Methods: We tested the impact of a chronic care model-based intervention program among 407 subjects with a recent stroke or transient ischemic attack at four Los Angeles County public hospitals. All subjects had a baseline systolic blood pressure (SBP) of at least 120 mm Hg and were randomized after baseline assessment in a 1:1 ratio to usual care or intervention, stratified by hospital and by English/Spanish language. The care management intervention was led by bilingual nurse practitioners or physician assistants, and it consisted of group clinics, self-management support, report cards, decision support, and coordination of ongoing care. Intention-to-treat analyses were conducted using repeated-measures mixed-effects models. The primary outcome was change in SBP. Secondary outcomes were other measures of SBP, low-density lipoprotein (LDL), ACC/AHA 10-year cardiovascular risk, adherence to antihypertensive and to antithrombotic medications, and physical activity. Results: Mean age was 57 years, 60% were male, 18% were African-American race, and 69% were Hispanic ethnicity. 48% had not graduated from high school. Baseline SBP was 150 mm Hg in the usual care arm and 149 mm Hg in the intervention arm. 12 month data were obtained in 333 participants (82%). There were substantial declines in SBP in both the usual care and intervention arms (Table). However, there were no significant differences between the two arms in either improvement of SBP from baseline or other measures of stroke risk factor control. Subgroup analyses did not reveal a differential impact of the intervention by race/ethnicity. Conclusion: Our care management intervention did not improve stroke risk factor control beyond what was attained in usual care. Further analyses are ongoing, and those findings will be used to guide modification of the intervention for future testing.

scholarly journals Does care in a specialised stroke prevention clinic improve poststroke blood pressure control: a protocol for a randomised comparative effectiveness study

BMJ Open ◽  
2019 ◽  
Vol 9 (2) ◽  
pp. e024695 ◽  
Author(s):  
Anjail Z Sharrief ◽  
Evelyn Hinojosa ◽  
Gail Cooksey ◽  
Munachi N Okpala ◽  
Elenir B Avritscher ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Risk Factor ◽  
Usual Care ◽  
Comparative Effectiveness ◽  
Primary Care Providers ◽  
Effectiveness Study ◽  
Care Providers ◽  
Stroke Risk Factor ◽  
Comparative Effectiveness Study ◽  
The Impact

IntroductionHypertension is a major risk factor for recurrent stroke, and blood pressure (BP) reduction is associated with decreased risk of stroke recurrence. However, many stroke survivors have poorly controlled BP after their initial stroke. The Stroke Transitions Education and Prevention (STEP) Clinic was established to provide a comprehensive approach to stroke risk factor reduction.Methods and analysisThis randomised comparative effectiveness study was designed to assess the impact of care in the STEP clinic versus usual care on poststroke BP reduction. Eligible hospitalised patients with ischaemic stroke, haemorrhagic stroke or transient ischaemic attack are scheduled for a clinic screening visit within 4 weeks of discharge if they meet baseline inclusion criteria. At the clinic visit, patients who have uncontrolled BP, defined as automated office BP ≥135/85 mm Hg are randomised (1:1) to either the STEP clinic or usual care for management. STEP clinic patients receive instructions to self-monitor, a BP monitor, sleep apnoea screening, dietary counselling, review of BP monitoring records and adjustment of medications. Patients are followed by a neurologist and a stroke-trained nurse practitioner. Usual care participants are seen by a neurologist and recommendations for secondary prevention are sent to primary care providers. The primary outcome is the difference in mean daytime ambulatory systolic BP at 6 months, assessed using linear regression analysis. Secondary outcomes include 24 hours ambulatory BP, medication adherence and medication self-efficacy, and composite cardiovascular events.Ethics and disseminationThis study was approved by the Institutional Review Boards at the McGovern Medical School at the University of Texas Health Sciences Center and the Georgetown University School of Medicine. Uninsured and Spanish-speaking patients are included in the study.Trial registration numberNCT02591394; Pre-results.

scholarly journals Mobile health as a viable strategy to enhance stroke risk factor control: A systematic review and meta-analysis

2017 ◽  
Vol 378 ◽  
pp. 140-145 ◽  
Author(s):  
Shimeng Liu ◽  
Wuwei Feng ◽  
Pratik Y. Chhatbar ◽  
Yumei Liu ◽  
Xunming Ji ◽  
...  
Keyword(s):  
Systematic Review ◽  
Risk Factor ◽  
Mobile Health ◽  
Stroke Risk ◽  
Meta Analysis ◽  
Risk Factor Control ◽  
Stroke Risk Factor

scholarly journals Prevalence, Impact, and Treatment of Co-Occurring Osteoarthritis in Patients With Stroke Undergoing Rehabilitation: A Review

Stroke ◽  
2021 ◽  
Author(s):  
John Fournier ◽  
Hillel Finestone ◽  
Julia Lauzon ◽  
T. Mark Campbell
Keyword(s):  
Risk Factor ◽  
Stroke Risk ◽  
Treatment Options ◽  
Stroke Recovery ◽  
High Quality Research ◽  
Stroke Risk Factor ◽  
Risk Factor Management ◽  
Function Management ◽  
The Impact

Background and Purpose: Early, frequent rehabilitation is an important factor for optimizing stroke recovery outcomes. Medical comorbidities, such as osteoarthritis, that affect the ability to participate in rehabilitation could therefore have a detrimental impact on such outcomes. Both stroke and osteoarthritis are becoming more common in developed nations as the population ages. First-line osteoarthritis treatments, such as oral nonsteroidal anti-inflammatory drugs, are often avoided poststroke due to interaction with secondary prevention stroke risk-factor management. Our objective was to summarize the current literature concerning co-occurring osteoarthritis and stroke prevalence, its functional impact, and treatment options. Methods: Narrative review using a comprehensive literature search of PubMed, osteoarthritis, and stroke guidelines. Outcomes related to co-occurrence prevalence, osteoarthritis as a stroke risk-factor, osteoarthritis-related imaging and treatment were extracted and summarized descriptively. Overall quality of the evidence was summarized using Grading of Recommendations Assessment, Development and Evaluation. Results: We identified 23 studies and guidelines related to our objective. Overall quality of the evidence was very low. Conclusions: Few trials have investigated the relationship between osteoarthritis and stroke, nor osteoarthritis-specific pain and function management for stroke survivors. High-quality research evaluating the impact of osteoarthritis on stroke rehabilitation is needed.

Abstract T P136: Potential Contributors to the Declining Impact of Stroke Risk Factors with Age: Implications for Stroke Epidemiology in the Elderly

Stroke ◽  
2014 ◽  
Vol 45 (suppl_1) ◽  
Author(s):  
George Howard ◽  
Mary Cushman ◽  
Maciej Banach ◽  
Brett M Kissela ◽  
David C Goff ◽  
...  
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
Stroke Risk ◽  
Multivariable Analysis ◽  
The Elderly ◽  
Stroke Risk Factors ◽  
Age Related ◽  
Increased Risk ◽  
The Impact ◽  
Age Related Changes

Purpose: The importance of stroke research in the elderly is increasing as America is “graying.” For most risk factors for most diseases (including stroke), the magnitude of association with incident events decreases at older ages. Potential changes in the impact of risk factors could be a “true” effect, or could be due to methodological issues such as age-related changes in residual confounding. Methods: REGARDS followed 27,748 stroke-free participants age 45 and over for an average of 5.3 years, during which 715 incident strokes occurred. The association of the “Framingham” risk factors (hypertension [HTN], diabetes, smoking, AFib, LVH and heart disease) with incident stroke risk was assessed in age strata of 45-64 (Young), 65-74 (Middle), and 75+ (Old). For those with and without an “index” risk factor (e.g., HTN), the average number of “other” risk factors was calculated. Results: With the exception of AFib, there was a monotonic decrease in the magnitude of the impact across the age strata, with HTN, diabetes, smoking and LVH even becoming non-significant in the elderly (Figure 1). However, for most factors, the increasing prevalence of other risk factors with age impacts primarily those with the index risk factor absent (Figure 2, example HTN as the “index” risk factor). Discussion: The impact of stroke risk factors substantially declined at older ages. However, this decrease is partially attributable to increases in the prevalence of other risk factors among those without the index risk factor, as there was little change in the prevalence of other risk factors in those with the index risk factor. Hence, the impact of the index risk factor is attenuated by increased risk in the comparison group. If this phenomenon is active with latent risk factors, estimates from multivariable analysis will also decrease with age. A deeper understanding of age-related changes in the impact of risk factors is needed.

Abstract T P95: Coronary Artery Disease in Moyamoya Disease

Stroke ◽  
2014 ◽  
Vol 45 (suppl_1) ◽  
Author(s):  
Kyung Il Jo ◽  
Jong Soo Kim ◽  
Seung-Chyul Hong ◽  
Je Young Yeon
Keyword(s):  
Coronary Artery Disease ◽  
Risk Factor ◽  
Coronary Artery ◽  
Moyamoya Disease ◽  
Stroke Risk ◽  
Bypass Graft ◽  
Coronary Artery Lesion ◽  
Conventional Coronary Angiography ◽  
Stroke Risk Factor ◽  
Artery Disease

Background and Purpose: Coronary artery disease in moyamoya disease (MMD) have been described sporadically in several case reports. The purpose of this study is to determine the prevalence and characteristics of coronary artery disease in patients with MMD. Methods: From August 1991 to December 2012, 446 patients diagnosed with adult MMD at our hospital. Baseline characteristics and prevalence of coronary artery disease were reviewed based on medical records and laboratory findings. The findings of conventional coronary angiography and/or coronary computed tomography were also reviewed for the presence and appearance of coronary artery lesion. Results: - Of 446 patients with adult MMD, 21 patients were found to have coronary artery disease. Ten patients were treated with coronary artery bypass graft (n=4) or percutaneous coronary intervention (n=6) for unstable angina or myocardial infarction. Eleven were treated with medication for stable angina (n=6) and variant angina with mild degree of stenosis (n=5). Median age at diagnosed with coronary artery disease of these patients were 44 (range, 27-59). Two patients showed calcification on coronary artery lesion. Comorbid stroke risk factor rate were 19%, 38%, 9.5% and 19 % in diabetes, hypertension, dyslipidemia and smoking. Six of 21 patients had more than 2 risk factor. Conclusion: - Twenty one (4.7%) of our adult MMD registry patients showed coronary artery disease. And only 2 (9.5%) showed calcification which might means that atherosclerosis burden is low in coronary artery disease with MMD. Coronary artery disease might be a clinically relevant systemic manifestation in patients with MMD, considering early onset coronary diseaes and low prevalence of stroke risk factor.

scholarly journals Epidemiologica and factors risk of stroke in Kemerovo

2008 ◽  
Vol 7 (5-1) ◽  
pp. 170-174
Author(s):  
A. V. Kovalenko ◽  
O. A. Gileva
Keyword(s):  
Risk Factor ◽  
Arterial Hypertension ◽  
Epidemiological Study ◽  
Stroke Risk ◽  
Cerebrovascular Disorders ◽  
Stroke Risk Factor ◽  
Cardiac Pathology ◽  
Prospective Epidemiological Study ◽  
Close Relatives

The paper presents the results of the first prospective epidemiological study of stroke in Kemerovo. The stroke was primary in 77,1% patients, the second one was in 22,9% patients. The frequency of the development of stroke increased with the years. The most prevalent risk factor was arterial hypertension which was recorded in 91,6% patients. Cardiac pathology as a stroke risk factor ranked second (61,7%). Cerebrovascular disorders in close relatives were registered in 55,5% patients. One-month lethality was 41,1%.

scholarly journals Pengetahuan Tentang Stroke, Faktor Risiko, Tanda Peringatan Stroke dan Respon Mencari Bantuan pada Pasien Stroke Iskemik

2019 ◽  
Vol 2 (2) ◽  
pp. 12
Author(s):  
Fitria Handayani
Keyword(s):  
Risk Factor ◽  
Medical Treatment ◽  
Stroke Risk ◽  
Treatment Engagement ◽  
Descriptive Study ◽  
Nursing Intervention ◽  
Knowledge Test ◽  
Stroke Risk Factor ◽  
Good Insight ◽  
Stroke Knowledge

Among stroke ischemic survivor, disability was contributed the stroke prevention and respon in medical treatment engagement when onset. Prevention stroke also was influenced the stroke knowledge. Stroke konowledge invarious population have studied. Meanwhile the the knowledge of stroke, risk factor,  symtom warning stroke, and respon to medical treatment engagement was not established in Indonesia. The aim of the study was to investigate the stroke knowledge among stroke ischemic survivor. Method was descriptive study. The sample were 78 samples. Quetionaire was Stroke Knowledge Test (SKT). Ethic was conducted by Ethic Committe of Medical Faculty Diponegoro University. The Result Showed that the knowledge of stroke, risk factor,  symtom warning stroke, and respon to medical treatment engagement were poor. This result gain the good insight in developing nursing intervention.

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