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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. 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. 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. 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. URL: http://www.clinicaltrials.gov. Unique
identifier: ACTRN12608000166370. |
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