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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

Participants with SBP, DBP and LDL-C below the target level at baseline and at 12 months.The lightly shaded portion of each 12 months stack represents the proportion of patients whose values changed from above target at baseline to below target at 12 months, whereas the dark shaded portion represents the proportion whose values remained below the target from baseline to 12 months. The differences observed between the intervention group and control group in the total proportion of participants with values below target at 12 months were significant with respect to SBP (p = 0.008) and LDL-C (p < 0.001). SBP, systolic blood pressure; DBP, diastolic blood pressure; LDL-C, low-density lipoprotein cholesterol.
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pone.0139997.g002: Participants with SBP, DBP and LDL-C below the target level at baseline and at 12 months.The lightly shaded portion of each 12 months stack represents the proportion of patients whose values changed from above target at baseline to below target at 12 months, whereas the dark shaded portion represents the proportion whose values remained below the target from baseline to 12 months. The differences observed between the intervention group and control group in the total proportion of participants with values below target at 12 months were significant with respect to SBP (p = 0.008) and LDL-C (p < 0.001). SBP, systolic blood pressure; DBP, diastolic blood pressure; LDL-C, low-density lipoprotein cholesterol.

Mentions: Compared to the control group, a significantly larger proportion of participants in the intervention group reached the SBP target value (absolute difference of 11.7%, 95% CI 3.1 to 20.1) at the 12-month follow-up (Fig 2).


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)

Participants with SBP, DBP and LDL-C below the target level at baseline and at 12 months.The lightly shaded portion of each 12 months stack represents the proportion of patients whose values changed from above target at baseline to below target at 12 months, whereas the dark shaded portion represents the proportion whose values remained below the target from baseline to 12 months. The differences observed between the intervention group and control group in the total proportion of participants with values below target at 12 months were significant with respect to SBP (p = 0.008) and LDL-C (p < 0.001). SBP, systolic blood pressure; DBP, diastolic blood pressure; LDL-C, low-density lipoprotein cholesterol.
© Copyright Policy
Related In: Results  -  Collection

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

pone.0139997.g002: Participants with SBP, DBP and LDL-C below the target level at baseline and at 12 months.The lightly shaded portion of each 12 months stack represents the proportion of patients whose values changed from above target at baseline to below target at 12 months, whereas the dark shaded portion represents the proportion whose values remained below the target from baseline to 12 months. The differences observed between the intervention group and control group in the total proportion of participants with values below target at 12 months were significant with respect to SBP (p = 0.008) and LDL-C (p < 0.001). SBP, systolic blood pressure; DBP, diastolic blood pressure; LDL-C, low-density lipoprotein cholesterol.
Mentions: Compared to the control group, a significantly larger proportion of participants in the intervention group reached the SBP target value (absolute difference of 11.7%, 95% CI 3.1 to 20.1) at the 12-month follow-up (Fig 2).

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