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Community-based Intervention to improve cardiometabolic targets in patients with stroke: A randomized controlled trial

Citation

Olaiya, MT and Cadilhac, DAC and Kim, J and Nelson, MR and Srikanth, VK and Gerraty, RP and Bladin, CF and Fitzgerald, SM and Phan, T and Frayne, J and Thrift, AG, Community-based Intervention to improve cardiometabolic targets in patients with stroke: A randomized controlled trial, Stroke, 48, (9) pp. 2504-2510. ISSN 0039-2499 (2017) [Refereed Article]


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DOI: doi:10.1161/STROKEAHA.117.017499

Abstract

Background and purpose: Many guidelines for secondary prevention of stroke focus on controlling cardiometabolic risk factors. We investigated the effectiveness of a management program for attaining cardiometabolic targets in survivors of stroke/transient ischemic attack.

Methods: Randomized controlled trial of survivors of stroke/transient ischemic attack aged ≥18 years. General practices were randomized to usual care (control) or an intervention comprising specialist review of care plans and nurse education in addition to usual care. The outcome is attainment of pre-defined cardiometabolic targets based on Australian guidelines. Multivariable regression was undertaken to determine efficacy and identify factors associated with attaining targets.

Results: Overall, 283 subjects were randomized to the intervention and 280 to controls. Although we found no between-group difference in overall cardiometabolic targets achieved at 12 months, the intervention group more often achieved control of low-density lipoprotein cholesterol (odds ratio, 1.97; 95% confidence interval, 1.18-3.29) than controls. At 24 months, no between-group differences were observed. Medication adherence was ≥80% at follow-up, but uptake of lifestyle/behavioral habits was poor. Older age, being male, being married/living with partner, and having greater functional ability or a history of diabetes mellitus were associated with attaining targets.

Conclusions: The intervention in this largely negative trial only had a detectable effect on attaining target for lipids but not for other factors at 12 months or any factor at 24 months. This limited effect may be attributable to inadequate uptake of behavioral/lifestyle interventions, highlighting the need for new or better approaches to achieve meaningful behavioral change.

Item Details

Item Type:Refereed Article
Keywords:cardiovascular diseases, goals, randomized controlled trial, risk factors, stroke
Research Division:Medical and Health Sciences
Research Group:Cardiorespiratory Medicine and Haematology
Research Field:Cardiology (incl. Cardiovascular Diseases)
Objective Division:Health
Objective Group:Clinical Health (Organs, Diseases and Abnormal Conditions)
Objective Field:Cardiovascular System and Diseases
Author:Nelson, MR (Professor Mark Nelson)
Author:Srikanth, VK (Dr Velandai Srikanth)
ID Code:121332
Year Published:2017
Deposited By:Menzies Institute for Medical Research
Deposited On:2017-09-23
Last Modified:2017-09-23
Downloads:0

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