Nurse-Led, Telephone-Based, Secondary Preventive Follow-Up after Stroke or Transient Ischemic Attack Improves Blood Pressure and LDL Cholesterol: Results from the First 12 Months of the Randomized, Controlled NAILED Stroke Risk Factor Trial.

Abstract

BACKGROUND:

Enhanced secondary preventive follow-up after stroke or transient ischemic attack (TIA) is necessary for improved adherence to recommendations regarding blood pressure (BP) and low-density lipoprotein cholesterol (LDL-C) levels. We investigated whether nurse-led, telephone-based follow-up was more efficient than usual care at improving BP and LDL-C levels at 12 months after hospital discharge.

METHODS:

We randomized 537 patients to either nurse-led, telephone-based follow-up (intervention) or usual care (control). BP and LDL-C measurements were performed at 1 month (baseline) and 12 months post-discharge. Intervention group patients who did not meet target values at baseline received additional follow-up, including titration of medication and lifestyle counselling, to reach treatment goals (BP < 140/90 mmHg, LDL-C < 2.5 mmol/L).

RESULTS:

At 12 months, mean systolic BP, diastolic BP and LDL-C was 3.3 (95% CI 0.3 to 6.3) mmHg, 2.3 mmHg (95% CI 0.5 to 4.2) and 0.3 mmol/L (95% CI 0.1 to 0.4) lower in the intervention group compared to controls. Among participants with values above the treatment goal at baseline, the difference in systolic BP and LDL-C was more pronounced (8.0 mmHg, 95% CI 4.0 to 12.1, and 0.6 mmol/L, 95% CI 0.4 to 0.9). A larger proportion of the intervention group reached the treatment goal for systolic BP (68.5 vs. 56.8%, p = 0.008) and LDL-C (69.7% vs. 50.4%, p < 0.001).

CONCLUSIONS:

Nurse-led, telephone-based secondary preventive follow-up, including medication adjustment, was significantly more efficient than usual care at improving BP and LDL-C levels by 12 months post-discharge.

TRIAL REGISTRATION:

ISRCTN Registry ISRCTN23868518.

• Authors: Anna-Lotta Irewall, Joachim Ögren, Lisa Bergström, Katarina Laurell, Lars Söderström, Thomas Mooe
• Journal: PloS one (PLoS One) Vol. 10 Issue 10 Pg. e0139997 ( 2015) ISSN: 1932-6203 [Electronic] United States
• PMID: 26474055 (Publication Type: Journal Article, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)

Chemical References

• Cholesterol, LDL

Topics

• Aged
• Aged, 80 and over
• Blood Pressure
• Brain Ischemia (blood, physiopathology, prevention & control)
• Cholesterol, LDL (blood)
• Female
• Follow-Up Studies
• Humans
• Interviews as Topic
• Male
• Middle Aged
• Nurses
• Risk Factors
• Stroke (blood, physiopathology, prevention & control)