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Nurse-Led, Telephone-Based, Secondary Preventive Follow-Up after Stroke or Transient Ischemic Attack Improves Blood Pressure and LDL Cholesterol: Results from the First 12 Months of the Randomized, Controlled NAILED Stroke Risk Factor Trial.

Irewall AL, Ögren J, Bergström L, Laurell K, Söderström L, Mooe T - PLoS ONE (2015)

Bottom Line: At 12 months, mean systolic BP, diastolic BP and LDL-C was 3.3 (95% CI 0.3 to 6.3) mmHg, 2.3 mmHg (95% CI 0.5 to 4.2) and 0.3 mmol/L (95% CI 0.1 to 0.4) lower in the intervention group compared to controls.Nurse-led, telephone-based secondary preventive follow-up, including medication adjustment, was significantly more efficient than usual care at improving BP and LDL-C levels by 12 months post-discharge.ISRCTN Registry ISRCTN23868518.

View Article: PubMed Central - PubMed

Affiliation: Department of Public Health and Clinical Medicine, Östersund, Umeå University, Umeå, Sweden.

ABSTRACT

Background: Enhanced secondary preventive follow-up after stroke or transient ischemic attack (TIA) is necessary for improved adherence to recommendations regarding blood pressure (BP) and low-density lipoprotein cholesterol (LDL-C) levels. We investigated whether nurse-led, telephone-based follow-up was more efficient than usual care at improving BP and LDL-C levels at 12 months after hospital discharge.

Methods: We randomized 537 patients to either nurse-led, telephone-based follow-up (intervention) or usual care (control). BP and LDL-C measurements were performed at 1 month (baseline) and 12 months post-discharge. Intervention group patients who did not meet target values at baseline received additional follow-up, including titration of medication and lifestyle counselling, to reach treatment goals (BP < 140/90 mmHg, LDL-C < 2.5 mmol/L).

Results: At 12 months, mean systolic BP, diastolic BP and LDL-C was 3.3 (95% CI 0.3 to 6.3) mmHg, 2.3 mmHg (95% CI 0.5 to 4.2) and 0.3 mmol/L (95% CI 0.1 to 0.4) lower in the intervention group compared to controls. Among participants with values above the treatment goal at baseline, the difference in systolic BP and LDL-C was more pronounced (8.0 mmHg, 95% CI 4.0 to 12.1, and 0.6 mmol/L, 95% CI 0.4 to 0.9). A larger proportion of the intervention group reached the treatment goal for systolic BP (68.5 vs. 56.8%, p = 0.008) and LDL-C (69.7% vs. 50.4%, p < 0.001).

Conclusions: Nurse-led, telephone-based secondary preventive follow-up, including medication adjustment, was significantly more efficient than usual care at improving BP and LDL-C levels by 12 months post-discharge.

Trial registration: ISRCTN Registry ISRCTN23868518.

No MeSH data available.


Related in: MedlinePlus

Study design flow-chart.Participants who were lost to follow-up during the 12-month period were not included in the final analysis due to missing values for BP and LDL-C from the 12-month follow-up measurement. BP, blood pressure; LDL-C, low-density lipoprotein cholesterol; TIA, Transient Ischemic Attack. * 1 month post-discharge. † The LDL-C target value only concerned participants who had experienced an ischemic stroke.
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pone.0139997.g001: Study design flow-chart.Participants who were lost to follow-up during the 12-month period were not included in the final analysis due to missing values for BP and LDL-C from the 12-month follow-up measurement. BP, blood pressure; LDL-C, low-density lipoprotein cholesterol; TIA, Transient Ischemic Attack. * 1 month post-discharge. † The LDL-C target value only concerned participants who had experienced an ischemic stroke.

Mentions: The flow of participants is illustrated in Fig 1. Out of the 537 patients originally randomized, a total of 484 participants, 276 male (57.0%) and 208 female (43.0%), completed the 12-month follow-up and were included in our final analysis. Stroke (63.2%, n = 306) was more common compared to TIA (36.8%, n = 178) and the mean patient age overall was 70.8 (±10.7). Detailed baseline characteristics are given in Table 1. The participants who were lost to follow-up (n = 53) were significantly older, more often female, and compared to the participants who completed the 12-month follow-up they showed a poorer functional status upon hospital discharge, with a higher prevalence of modified Rankin Scale ≥ 3, congestive heart failure and atrial fibrillation.


Nurse-Led, Telephone-Based, Secondary Preventive Follow-Up after Stroke or Transient Ischemic Attack Improves Blood Pressure and LDL Cholesterol: Results from the First 12 Months of the Randomized, Controlled NAILED Stroke Risk Factor Trial.

Irewall AL, Ögren J, Bergström L, Laurell K, Söderström L, Mooe T - PLoS ONE (2015)

Study design flow-chart.Participants who were lost to follow-up during the 12-month period were not included in the final analysis due to missing values for BP and LDL-C from the 12-month follow-up measurement. BP, blood pressure; LDL-C, low-density lipoprotein cholesterol; TIA, Transient Ischemic Attack. * 1 month post-discharge. † The LDL-C target value only concerned participants who had experienced an ischemic stroke.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4608694&req=5

pone.0139997.g001: Study design flow-chart.Participants who were lost to follow-up during the 12-month period were not included in the final analysis due to missing values for BP and LDL-C from the 12-month follow-up measurement. BP, blood pressure; LDL-C, low-density lipoprotein cholesterol; TIA, Transient Ischemic Attack. * 1 month post-discharge. † The LDL-C target value only concerned participants who had experienced an ischemic stroke.
Mentions: The flow of participants is illustrated in Fig 1. Out of the 537 patients originally randomized, a total of 484 participants, 276 male (57.0%) and 208 female (43.0%), completed the 12-month follow-up and were included in our final analysis. Stroke (63.2%, n = 306) was more common compared to TIA (36.8%, n = 178) and the mean patient age overall was 70.8 (±10.7). Detailed baseline characteristics are given in Table 1. The participants who were lost to follow-up (n = 53) were significantly older, more often female, and compared to the participants who completed the 12-month follow-up they showed a poorer functional status upon hospital discharge, with a higher prevalence of modified Rankin Scale ≥ 3, congestive heart failure and atrial fibrillation.

Bottom Line: At 12 months, mean systolic BP, diastolic BP and LDL-C was 3.3 (95% CI 0.3 to 6.3) mmHg, 2.3 mmHg (95% CI 0.5 to 4.2) and 0.3 mmol/L (95% CI 0.1 to 0.4) lower in the intervention group compared to controls.Nurse-led, telephone-based secondary preventive follow-up, including medication adjustment, was significantly more efficient than usual care at improving BP and LDL-C levels by 12 months post-discharge.ISRCTN Registry ISRCTN23868518.

View Article: PubMed Central - PubMed

Affiliation: Department of Public Health and Clinical Medicine, Östersund, Umeå University, Umeå, Sweden.

ABSTRACT

Background: Enhanced secondary preventive follow-up after stroke or transient ischemic attack (TIA) is necessary for improved adherence to recommendations regarding blood pressure (BP) and low-density lipoprotein cholesterol (LDL-C) levels. We investigated whether nurse-led, telephone-based follow-up was more efficient than usual care at improving BP and LDL-C levels at 12 months after hospital discharge.

Methods: We randomized 537 patients to either nurse-led, telephone-based follow-up (intervention) or usual care (control). BP and LDL-C measurements were performed at 1 month (baseline) and 12 months post-discharge. Intervention group patients who did not meet target values at baseline received additional follow-up, including titration of medication and lifestyle counselling, to reach treatment goals (BP < 140/90 mmHg, LDL-C < 2.5 mmol/L).

Results: At 12 months, mean systolic BP, diastolic BP and LDL-C was 3.3 (95% CI 0.3 to 6.3) mmHg, 2.3 mmHg (95% CI 0.5 to 4.2) and 0.3 mmol/L (95% CI 0.1 to 0.4) lower in the intervention group compared to controls. Among participants with values above the treatment goal at baseline, the difference in systolic BP and LDL-C was more pronounced (8.0 mmHg, 95% CI 4.0 to 12.1, and 0.6 mmol/L, 95% CI 0.4 to 0.9). A larger proportion of the intervention group reached the treatment goal for systolic BP (68.5 vs. 56.8%, p = 0.008) and LDL-C (69.7% vs. 50.4%, p < 0.001).

Conclusions: Nurse-led, telephone-based secondary preventive follow-up, including medication adjustment, was significantly more efficient than usual care at improving BP and LDL-C levels by 12 months post-discharge.

Trial registration: ISRCTN Registry ISRCTN23868518.

No MeSH data available.


Related in: MedlinePlus