Effectiveness of a shared team approach between nurses and doctors for improved risk factor management in survivors of stroke: a cluster randomized controlled trial

• Published in: European journal of neurology Vol. 24; no. 7; pp. 920 - 928
• Main Authors: Olaiya, M. T., Kim, J., Nelson, M. R., Srikanth, V. K., Bladin, C. F., Gerraty, R. P., Fitzgerald, S. M., Phan, T., Frayne, J., Cadilhac, D. A., Thrift, A. G., Johnston, Colin I., Bernhardt, Julie, Macdonell, Richard A.L., Churilov, Leonid
• Format: Journal Article
• Language: English
• Published: England John Wiley & Sons, Inc 01.07.2017
• Subjects: Aged; Aged, 80 and over; Cardiovascular diseases; Clinical trials; Clusters; Confidence intervals; Disability Evaluation; Disease control; Disease Management; Female; Health risks; Hospitals; Humans; Intervention; Ischemic Attack, Transient - therapy; Male; Medical personnel; Middle Aged; Motivation; Nurses; Patient Care Team; Patient Education as Topic; Patients; Physicians; Precision Medicine; Prevention; Prospective Studies; Randomization; randomized clinical trial; Risk Factors; Risk management; secondary prevention; Stroke; Stroke - mortality; Stroke - therapy; transient ischaemic attack; Transient ischemic attack; Treatment Outcome; randomized clinical trial; risk factors; transient ischaemic attack; secondary prevention; stroke
• ISSN: 1351-5101; 1468-1331
• DOI: 10.1111/ene.13306

Background and purpose Limited evidence exists on the benefits of organized care for improving risk factor control in patients with stroke or transient ischaemic attack. The effectiveness of an individualized management programme in reducing absolute cardiovascular disease risk in this high‐risk population was determined. Methods This was a prospective, multicentre, cluster‐randomized controlled trial with blinded assessment of outcomes and intention‐to‐treat analysis. Patients hospitalized for stroke/transient ischaemic attack and aged ≥18 years were recruited from four hospitals. General practices treating recruited patients were randomized to provide either usual care or an individualized management programme comprising nurse‐led education and review of care plans by stroke specialists in addition to usual care. The primary outcome was a change in cardiovascular Framingham Risk Score between baseline and 12 months. Results From January 2010 to November 2013, 156 general practices (280 patients) were randomly assigned to usual care (control) and 159 (283 patients) to the intervention. The median age was 70.1 years; 65% were male. Overall, >80% of participants were prescribed recommended secondary prevention therapies at baseline. The primary efficacy analysis comprised 533 participants, with 30 either dying or lost to follow‐up. In adjusted analyses, no significant between‐group difference was found in the cardiovascular risk score at 12 months (0.04, 95% confidence interval −1.7, 1.8). Conclusions The effectiveness of an organized secondary prevention programme for stroke may be limited in patients from high‐performing hospitals with regular post‐discharge follow‐up and communication with general practices.