Community-Based Intervention to Improve Cardiometabolic Targets in Patients With Stroke: A Randomized Controlled Trial

Research output: Contribution to journalArticleResearchpeer-review

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.

Clinical Trial Registration—URL: http://www.clinicaltrials.gov. Unique identifier: ACTRN12608000166370.


Original languageEnglish
Pages (from-to)2504 - 2510
Number of pages7
JournalStroke
Volume48
Issue number9
DOIs
Publication statusPublished - Sep 2017

Cite this

@article{8708e61d4b014b999006e04e3bcf5515,
title = "Community-Based Intervention to Improve Cardiometabolic Targets in Patients With Stroke: A Randomized Controlled Trial",
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.Clinical Trial Registration—URL: http://www.clinicaltrials.gov. Unique identifier: ACTRN12608000166370.",
author = "Olaiya, {Muideen T.} and Cadilhac, {Dominique A.} and Joosup Kim and Nelson, {Mark R.} and Srikanth, {Velandai K.} and Gerraty, {Richard P.} and Bladin, {Christopher F.} and Fitzgerald, {Sharyn M.} and Thanh Phan and Judith Frayne and Thrift, {Amanda G.}",
year = "2017",
month = "9",
doi = "10.1161/STROKEAHA.117.017499",
language = "English",
volume = "48",
pages = "2504 -- 2510",
journal = "Stroke",
issn = "0039-2499",
publisher = "American Heart Association",
number = "9",

}

TY - JOUR

T1 - Community-Based Intervention to Improve Cardiometabolic Targets in Patients With Stroke

T2 - A Randomized Controlled Trial

AU - Olaiya, Muideen T.

AU - Cadilhac, Dominique A.

AU - Kim, Joosup

AU - Nelson, Mark R.

AU - Srikanth, Velandai K.

AU - Gerraty, Richard P.

AU - Bladin, Christopher F.

AU - Fitzgerald, Sharyn M.

AU - Phan, Thanh

AU - Frayne, Judith

AU - Thrift, Amanda G.

PY - 2017/9

Y1 - 2017/9

N2 - 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.Clinical Trial Registration—URL: http://www.clinicaltrials.gov. Unique identifier: ACTRN12608000166370.

AB - 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.Clinical Trial Registration—URL: http://www.clinicaltrials.gov. Unique identifier: ACTRN12608000166370.

U2 - 10.1161/STROKEAHA.117.017499

DO - 10.1161/STROKEAHA.117.017499

M3 - Article

VL - 48

SP - 2504

EP - 2510

JO - Stroke

JF - Stroke

SN - 0039-2499

IS - 9

ER -