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Title: Community-Based Intervention to Improve Cardiometabolic Targets in Patients With Stroke: A Randomized Controlled Trial.
Austin Authors: Olaiya, Muideen T;Cadilhac, Dominique A;Kim, Joosup;Nelson, Mark R;Srikanth, Velandai K;Gerraty, Richard P;Bladin, Christopher F;Fitzgerald, Sharyn M;Phan, Thanh;Frayne, Judith;Thrift, Amanda G
Affiliation: Stroke Division, Florey Institute of Neuroscience and Mental Health, Heidelberg, Victoria, Australia
Menzies Institute for Medical Research, Hobart, Tasmania, Australia
Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia
Department of Epidemiology and Preventive Medicine, Monash University, Clayton, Victoria, Australia
Department of Medicine, Epworth Healthcare, Richmond, Victoria, Australia
Department of Neurosciences, Box Hill Hospital, Victoria, Australia
Department of Neurology, Alfred Hospital, Melbourne, Victoria, Australia
Issue Date: 28-Jul-2017 2017
Publication information: Stroke 2017; 48(9): 2504-2510
Abstract: 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: Unique identifier: ACTRN12608000166370.
DOI: 10.1161/STROKEAHA.117.017499
ORCID: 0000-0001-8162-682X
Journal: Stroke
PubMed URL: 28754834
Type: Journal Article
Subjects: cardiovascular diseases
randomized controlled trial
Risk Factors
Appears in Collections:Journal articles

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