Focus on BP and lipids could be paradigm shift for preventing recurrent stroke

Risk factors

By Nicola Garrett

13 Mar 2019

Stroke survivors participating in a shared care prevention model focusing on hypertension and lipids are more likely to reduce risk factors for recurrent stroke, Victorian research shows.

The findings have the potential to instigate a paradigm shift in the overall stroke survivor management to reduce recurrent stroke, according to Dr Jacques Joubert a neurologist from St Vincent’s Hospital in Melbourne.

The double-blind randomised trial tested the Integrated Care for the Reduction of Secondary Stroke (ICARUSS) model in 112 stroke survivors who were admitted to stroke units and subsequently discharged into the care of their primary physician.

The model was a multifaceted integrated program involving bidirectional feedback between the patients’ GP and the specialist unit. Patients and their carers received education on self management, with ongoing input from a multidisciplinary team.

Results showed that at 12 month follow-up the intervention had “significantly positive effects” compared to usual care on two of the three guidelines for treatable risk factors for stroke – blood pressure and cholesterol.

For example, patients who had participated in the program had lower systolic blood pressure from baseline compared to those who had received usual care (5.2mmHg P<0.01), achieving a targeted mean systolic blood pressure of less than 130 mmHg.

Fasting total cholesterol as well as triglycerides was also significantly reduced in the intervention group (both p < 0.01).

Positive results were also seen for modifiable behavioural risk factors such as BMI, physical activity and alcohol abuse compared to usual care.

“Extrapolation of [the findings] to a longer duration cohort study would suggest that recurrent stroke and vascular death would be significantly reduced in stroke survivors exposed to this integrated care model,” the study authors concluded in their paper published in the International Journal of Stroke.

They added that the model could “potentially lead to a paradigm shift in the overall  stroke survivor management, thereby promoting world-wide efforts to achieve the target of potentially preventing 75-80% of recurrent events in stroke survivors as predicted by Hachinski.”

The authors noted that the effects of the ICARUSS intervention were significantly more positive on risk factor management than has been seen in other studies.

“The reasons for this are unclear but a paradigm shift from a fractional (silo) model such as the nurse led model to a truly integrated shared care model may be important,” they said.

They added that ongoing work was needed to determine the reasons behind the implementation/recommendation gap that currently existed in stroke prevention and how to sustain the involvement of both stroke survivors and their carers.

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