Abstract P322: Goals for Cardiometabolic Risk Factors are Still Not Being Attained in the Long Term After Stroke or Transient Ischaemic Attack
Introduction: Clinical guidelines for patients with stroke or TIA have focused on modification of lifestyle and treatment to achieve cardometabolic risk factor goals. However, there is limited evidence on effective attainment of these goals in this high-risk population.
Hypothesis: We hypothesised that a one-year intervention program will improve the attainment of cardiometabolic risk factor goals in community-dwelling survivors of stroke or TIA.
Methods: Shared Team Approach between Nurses and Doctors For Improved Risk Factor Management (STANDFIRM) trial is an on-going prospective, randomised controlled trial of risk factor management in people with stroke or TIA. Patients hospitalised for stroke/TIA, and aged ≥18 years, were provided an intervention comprising an individualised, evidence-based secondary prevention program, including nurse education visits, and management plan with specialist oversight. The study outcome was attainment of blood pressure, blood cholesterol, blood sugar, body composition, kidney function goals, and smoking cessation at 12 months, based on guideline recommendations. We assessed whether lifestyle or other factors were associated with achieving an increased number of goals. Data collection comprised surveys, anthropometric and biochemical measurements. Differences in the proportion of patients meeting the set goals at baseline and 12 months were determined using McNemar’s chi-square test. The association between baseline factors and goal attainment was determined using multivariable linear regression.
Results: Between January 2010 and November 2013, 233 patients (66% male, median age 69 years, 77% ischaemic stroke) were recruited into the intervention arm of the trial. Between baseline and 12 months, there was no difference in the proportion of patients achieving each of the set goals. Overall, only 14 patients (3%) achieved all six measured goals. A total of 90 patients (34%) met ≥4 goals, 89 (34%) met 3 goals, and 84 (32%) met ≤2 goals. In multivariable analyses, factors independently associated with achieving more goals included being female (OR 1.70, 95% CI 1.27, 2.20), having vocational or higher education (OR 1.37, 95% CI 1.05, 1.80), and lower salt intake at baseline (OR 0.98, 95% CI 0.97, 1.00).
Conclusion: The 12-month intervention did not have an impact on the attainment of cardiometabolic goals in patients with stroke or TIA. With few individual factors identified, further investigation of system-level factors is warranted to ascertain factors that could facilitate improved risk factor management in patients with stroke or TIA.
Author Disclosures: M.T. Olaiya: None. D.A. Cadilhac: None. J. Kim: None. M.R. Nelson: None. V.K. Srikanth: None. C.F. Bladin: None. R.P. Gerraty: None. S.M. Fitzgerald: None. T. Phan: E. Honoraria; Significant; For presentations given for Bayer, Boehringer Ingelheim, Genzyme, Pfizer, and BMS. J. Frayne: None. A.G. Thrift: None.
- © 2016 by American Heart Association, Inc.