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Title: Effectiveness of a shared team approach between nurses and doctors for improved risk factor management in survivors of stroke: a cluster randomized controlled trial.
Authors: Gerraty, Richard
Other Authors: Olaiya, Muideen
Kim, Jossup
Nelson, Mark
Srikanth, Velandai
Bladin, Christopher
Fitzgerald, Sharyn
Phan, Thanh
Frayne, Judith
Cadilhac, Dominique
Thrift, Amanda
Keywords: Transient Ischaemic Attack
Risk Factors
Cardiovascular Disease Risk
Secondary Prevention
Individualized Management Programme
Randomized Clinical Trial
Usual Care
Nurse-Led Education
Stroke Specialists
Care Plans
Cardiovascular Framingham Risk Score
Secondary Prevention Therapies
Neurosciences Clinical Institute, Epworth HealthCare, Victoria, Australia
Department of Medicine, Epworth Healthcare, Australia.
Issue Date: Jul-2017
Publisher: Wiley Online Library
Citation: Eur J Neurol. 2017 Jul;24(7):920-928
Abstract: BACKGROUND AND PURPOSE: Limited evidence exists on the benefits of organized care for improving risk factor control in patients with stroke or transient ischaemic attack. The effectiveness of an individualized management programme in reducing absolute cardiovascular disease risk in this high-risk population was determined. METHODS: This was a prospective, multicentre, cluster-randomized controlled trial with blinded assessment of outcomes and intention-to-treat analysis. Patients hospitalized for stroke/transient ischaemic attack and aged ≥18 years were recruited from four hospitals. General practices treating recruited patients were randomized to provide either usual care or an individualized management programme comprising nurse-led education and review of care plans by stroke specialists in addition to usual care. The primary outcome was a change in cardiovascular Framingham Risk Score between baseline and 12 months. RESULTS: From January 2010 to November 2013, 156 general practices (280 patients) were randomly assigned to usual care (control) and 159 (283 patients) to the intervention. The median age was 70.1 years; 65% were male. Overall, >80% of participants were prescribed recommended secondary prevention therapies at baseline. The primary efficacy analysis comprised 533 participants, with 30 either dying or lost to follow-up. In adjusted analyses, no significant between-group difference was found in the cardiovascular risk score at 12 months (0.04, 95% confidence interval -1.7, 1.8). CONCLUSIONS: The effectiveness of an organized secondary prevention programme for stroke may be limited in patients from high-performing hospitals with regular post-discharge follow-up and communication with general practices.
DOI: 10.1111/ene.13306
PubMed URL:
ISSN: 1468-1331
Journal Title: European Journal of Neurology
Type: Journal Article
Affiliated Organisations: Stroke and Ageing Research, School of Clinical Sciences at Monash Health, Monash University, Clayton, Vic., Australia.
Stroke Division, Florey Institute of Neuroscience and Mental Health, Parkville, Vic, Australia.
Menzies Institute for Medical Research, Hobart, Tas, Australia.
Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Vic., Australia.
Department of Neurosciences, Box Hill Hospital, Box Hill, Vic., Australia.
Department of Neurology, Alfred Hospital, Melbourne, Vic., Australia.
Type of Clinical Study or Trial: Multicentre Studies
Appears in Collections:Neurosciences

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