Secondary prevention after minor stroke and TIA - usual care and development of a support program.

Effective methods of secondary prevention after stroke or TIA are available but adherence to recommended evidence-based treatments is often poor. The study aimed to determine the quality of secondary prevention in usual care and to develop a stepwise modeled support program.Two consecutive cohorts o...

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Main Authors: Stefanie Leistner, Steffen Benik, Inga Laumeier, Annerose Ziegler, Gabriele Nieweler, Christian H Nolte, Peter U Heuschmann, Heinrich J Audebert
Format: Article
Language:English
Published: Public Library of Science (PLoS) 2012-01-01
Series:PLoS ONE
Online Access:http://europepmc.org/articles/PMC3524242?pdf=render
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spelling doaj-063273c7c66247aba7ed8f0ae16990c72020-11-25T01:45:09ZengPublic Library of Science (PLoS)PLoS ONE1932-62032012-01-01712e4998510.1371/journal.pone.0049985Secondary prevention after minor stroke and TIA - usual care and development of a support program.Stefanie LeistnerSteffen BenikInga LaumeierAnnerose ZieglerGabriele NiewelerChristian H NoltePeter U HeuschmannHeinrich J AudebertEffective methods of secondary prevention after stroke or TIA are available but adherence to recommended evidence-based treatments is often poor. The study aimed to determine the quality of secondary prevention in usual care and to develop a stepwise modeled support program.Two consecutive cohorts of patients with acute minor stroke or TIA undergoing usual outpatient care versus a secondary prevention program were compared. Risk factor control and medication adherence were assessed in 6-month follow-ups (6M-FU). Usual care consisted of detailed information concerning vascular risk factor targets given at discharge and regular outpatient care by primary care physicians. The stepwise modeled support program additionally employed up to four outpatient appointments. A combination of educational and behavioral strategies was employed.168 patients in the observational cohort who stated their openness to participate in a prevention program (mean age 64.7 y, admission blood pressure (BP): 155/84 mmHg) and 173 patients participating in the support program (mean age 67.6 y, BP: 161/84 mmHg) were assessed at 6 months. Proportions of patients with BP according to guidelines were 50% in usual-care and 77% in the support program (p<0.01). LDL<100 mg/dl was measured in 62 versus 71% (p = 0.12). Proportions of patients who stopped smoking were 50 versus 79% (p<0.01). 72 versus 89% of patients with atrial fibrillation were on oral anticoagulation (p = 0.09).Risk factor control remains unsatisfactory in usual care. Targets of secondary prevention were met more often within the supported cohort. Effects on (cerebro-)vascular recurrence rates are going to be assessed in a multicenter randomized trial.http://europepmc.org/articles/PMC3524242?pdf=render
collection DOAJ
language English
format Article
sources DOAJ
author Stefanie Leistner
Steffen Benik
Inga Laumeier
Annerose Ziegler
Gabriele Nieweler
Christian H Nolte
Peter U Heuschmann
Heinrich J Audebert
spellingShingle Stefanie Leistner
Steffen Benik
Inga Laumeier
Annerose Ziegler
Gabriele Nieweler
Christian H Nolte
Peter U Heuschmann
Heinrich J Audebert
Secondary prevention after minor stroke and TIA - usual care and development of a support program.
PLoS ONE
author_facet Stefanie Leistner
Steffen Benik
Inga Laumeier
Annerose Ziegler
Gabriele Nieweler
Christian H Nolte
Peter U Heuschmann
Heinrich J Audebert
author_sort Stefanie Leistner
title Secondary prevention after minor stroke and TIA - usual care and development of a support program.
title_short Secondary prevention after minor stroke and TIA - usual care and development of a support program.
title_full Secondary prevention after minor stroke and TIA - usual care and development of a support program.
title_fullStr Secondary prevention after minor stroke and TIA - usual care and development of a support program.
title_full_unstemmed Secondary prevention after minor stroke and TIA - usual care and development of a support program.
title_sort secondary prevention after minor stroke and tia - usual care and development of a support program.
publisher Public Library of Science (PLoS)
series PLoS ONE
issn 1932-6203
publishDate 2012-01-01
description Effective methods of secondary prevention after stroke or TIA are available but adherence to recommended evidence-based treatments is often poor. The study aimed to determine the quality of secondary prevention in usual care and to develop a stepwise modeled support program.Two consecutive cohorts of patients with acute minor stroke or TIA undergoing usual outpatient care versus a secondary prevention program were compared. Risk factor control and medication adherence were assessed in 6-month follow-ups (6M-FU). Usual care consisted of detailed information concerning vascular risk factor targets given at discharge and regular outpatient care by primary care physicians. The stepwise modeled support program additionally employed up to four outpatient appointments. A combination of educational and behavioral strategies was employed.168 patients in the observational cohort who stated their openness to participate in a prevention program (mean age 64.7 y, admission blood pressure (BP): 155/84 mmHg) and 173 patients participating in the support program (mean age 67.6 y, BP: 161/84 mmHg) were assessed at 6 months. Proportions of patients with BP according to guidelines were 50% in usual-care and 77% in the support program (p<0.01). LDL<100 mg/dl was measured in 62 versus 71% (p = 0.12). Proportions of patients who stopped smoking were 50 versus 79% (p<0.01). 72 versus 89% of patients with atrial fibrillation were on oral anticoagulation (p = 0.09).Risk factor control remains unsatisfactory in usual care. Targets of secondary prevention were met more often within the supported cohort. Effects on (cerebro-)vascular recurrence rates are going to be assessed in a multicenter randomized trial.
url http://europepmc.org/articles/PMC3524242?pdf=render
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