Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
Trials
Published in: Trials 1/2019

Open Access 01-12-2019 | Stroke | Research

Nurse-led, telephone-based secondary preventive follow-up benefits stroke/TIA patients with low education: a randomized controlled trial sub-study

Authors: Anna-Lotta Irewall, Joachim Ögren, Lisa Bergström, Katarina Laurell, Lars Söderström, Thomas Mooe

Published in: Trials | Issue 1/2019

Login to get access

Abstract

Background

The objective of this study was to analyze the impact of two forms of secondary preventive follow-up on the association between education level and levels of blood pressure (BP) and low-density lipoprotein cholesterol (LDL-C) after stroke/transient ischemic attack (TIA).

Methods

We included a population-based cohort of 771 stroke and TIA patients randomly assigned (1:1) to secondary preventive follow-up within primary health care (control) or nurse-led, telephone-based follow-up (intervention) between January 1, 2010, and December 31, 2013, as part of the NAILED (nurse-based age-independent intervention to limit evolution of disease) stroke risk factor trial. We compared BP and LDL-C levels 12 months after hospital discharge in relation to education level (low, ≤10 years; high, >10 years) separately for the intervention and control groups.

Results

Among controls, systolic BP (SBP) decreased only among the highly educated (−2.5 mm Hg, 95% confidence interval (CI) −0.2 to −4.8), whereas LDL-C increased in the low-education group (0.2 mmol/L, 95% CI 0.1 to 0.3). At 12 months, controls with low education not more than 70 years of age had higher SBP than controls of the same age with high education (5.8 mm Hg, 95% CI 1.0 to 10.6). In contrast, SBP in the intervention group decreased similarly regardless of education level, LDL-C decreased among those with low education (−0.3 mmol/L, 95% CI −0.2 to −0.4) and, in the subgroup not more than 70 years old, low-educated participants had lower LDL-C at 12 months than those with high education (0.3 mmol/L, 95% CI 0.1 to 0.5).

Conclusions

Nurse-led, telephone-based secondary preventive follow-up led to comparable improvements in BP across education groups, while routine follow-up disfavored those with low education.

Trial registration

ISRCTN Registry ISRCTN23868518, June 19, 2012 - Retrospectively registered.
Literature
1.
Mohan KM, Wolfe CD, Rudd AG, Heuschmann PU, Kolominsky-Rabas PL, Grieve AP. Risk and cumulative risk of stroke recurrence: a systematic review and meta-analysis. Stroke. 2011;42:1489–94.CrossRef
2.
Feng W, Hendry RM, Adams RJ. Risk of recurrent stroke, myocardial infarction, or death in hospitalized stroke patients. Neurology. 2010;74:588–93.CrossRef
3.
Clark TG, Murphy MF, Rothwell PM. Long term risks of stroke, myocardial infarction, and vascular death in "low risk" patients with a non-recent transient ischaemic attack. J Neurol Neurosurg Psychiatry. 2003;74:577–80.CrossRef
4.
Pennlert J, Eriksson M, Carlberg B, Wiklund PG. Long-term risk and predictors of recurrent stroke beyond the acute phase. Stroke. 2014;45:1839–41.CrossRef
5.
Burns JD, Rabinstein AA, Roger VL, Stead LG, Christianson TJ, Killian JM, et al. Incidence and predictors of myocardial infarction after transient ischemic attack: a population-based study. Stroke. 2011;42:935–40.CrossRef
6.
Liu L, Wang Z, Gong L, Zhang Y, Thijs L, Staessen JA, et al. Blood pressure reduction for the secondary prevention of stroke: a Chinese trial and a systematic review of the literature. Hypertens Res. 2009;32:1032–40.CrossRef
7.
Amarenco P, Bogousslavsky J, Callahan A 3rd, Goldstein LB, Hennerici M, Rudolph AE, et al. High-dose atorvastatin after stroke or transient ischemic attack. N Engl J Med. 2006;355:549–59.CrossRef
8.
Brewer L, Mellon L, Hall P, Dolan E, Horgan F, Shelley E, et al. Secondary prevention after ischaemic stroke: the ASPIRE-S study. BMC Neurol. 2015;15:216.CrossRef
9.
Alvarez-Sabin J, Quintana M, Hernandez-Presa MA, Alvarez C, Chaves J, Ribo M. Therapeutic interventions and success in risk factor control for secondary prevention of stroke. J Stroke Cerebrovasc Dis. 2009;18:460–5.CrossRef
10.
Heuschmann PU, Kircher J, Nowe T, Dittrich R, Reiner Z, Cifkova R, et al. Control of main risk factors after ischaemic stroke across Europe: data from the stroke-specific module of the EUROASPIRE III survey. Eur J Prev Cardiol. 2015;22:1354–62.CrossRef
11.
Krieger N, Williams DR, Moss NE. Measuring social class in US public health research: concepts, methodologies, and guidelines. Annu Rev Public Health. 1997;18:341–78.CrossRef
12.
Galobardes B, Shaw M, Lawlor DA, Lynch JW, Davey Smith G. Indicators of socioeconomic position (part 1). J Epidemiol Community Health. 2006;60:7–12.CrossRef
13.
Rosvall M, Engstrom G, Hedblad B, Janzon L, Goran B. The role of preclinical atherosclerosis in the explanation of educational differences in incidence of coronary events. Atherosclerosis. 2006;187:251–6.CrossRef
14.
Rosengren A, Subramanian SV, Islam S, Chow CK, Avezum A, Kazmi K, et al. Education and risk for acute myocardial infarction in 52 high, middle and low-income countries: INTERHEART case-control study. Heart. 2009;95:2014–22.CrossRef
15.
Malki N, Koupil I, Eloranta S, Weibull CE, Tiikkaja S, Ingelsson E, et al. Temporal trends in incidence of myocardial infarction and ischemic stroke by socioeconomic position in Sweden 1987-2010. PLoS One. 2014;9:e105279.CrossRef
16.
Blomstrand A, Blomstrand C, Ariai N, Bengtsson C, Bjorkelund C. Stroke incidence and association with risk factors in women: a 32-year follow-up of the Prospective Population Study of Women in Gothenburg. BMJ Open. 2014;4:e005173.CrossRef
17.
Addo J, Ayerbe L, Mohan KM, Crichton S, Sheldenkar A, Chen R, et al. Socioeconomic status and stroke: an updated review. Stroke. 2012;43:1186–91.CrossRef
18.
Cox AM, McKevitt C, Rudd AG, Wolfe CD. Socioeconomic status and stroke. Lancet Neurol. 2006;5:181–8.CrossRef
19.
20.
Kestila P, Magnussen CG, Viikari JS, Kahonen M, Hutri-Kahonen N, Taittonen L, et al. Socioeconomic status, cardiovascular risk factors, and subclinical atherosclerosis in young adults: the cardiovascular risk in Young Finns Study. Arterioscler Thromb Vasc Biol. 2012;32:815–21.CrossRef
21.
Ernstsen L, Strand BH, Nilsen SM, Espnes GA, Krokstad S. Trends in absolute and relative educational inequalities in four modifiable ischaemic heart disease risk factors: repeated cross-sectional surveys from the Nord-Trondelag Health Study (HUNT) 1984-2008. BMC Public Health. 2012;12:266.CrossRef
22.
Kuper H, Adami HO, Theorell T, Weiderpass E. The socioeconomic gradient in the incidence of stroke: a prospective study in middle-aged women in Sweden. Stroke. 2007;38:27–33.CrossRef
23.
Mooe T, Bergstrom L, Irewall AL, Ogren J. The NAILED stroke risk factor trial (nurse based age independent intervention to limit evolution of disease after stroke): study protocol for a randomized controlled trial. Trials. 2013;14:5.CrossRef
24.
Irewall AL, Ogren J, Bergstrom L, Laurell K, Soderstrom L, Mooe T. 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. PLoS One. 2015;10:e0139997.CrossRef
25.
26.
27.
Larsson E, Westberg J. Utbildningshistoria. 1st ed. Lund: Studentlitteratur; 2011.
28.
Lim SSVT, Flaxman AD, Danaei G, Shibuya K, Adair-Rohani H, Amann M, et al. A comparative risk assessment of burden of disease and injury attributable to 67 risk factors and risk factor clusters in 21 regions, 1990-2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet. 2012;380:2224–60.CrossRef
29.
Huang K, Khan N, Kwan A, Fang J, Yun L, Kapral MK. Socioeconomic status and care after stroke: results from the Registry of the Canadian Stroke Network. Stroke. 2013;44:477–82.CrossRef
30.
Arrich J, Mullner M, Lalouschek W, Greisenegger S, Crevenna R, Herkner H. Influence of socioeconomic status and gender on stroke treatment and diagnostics. Stroke. 2008;39:2066–72.CrossRef
31.
Chen R, McKevitt C, Crichton SL, Rudd AG, Wolfe CD. Socioeconomic deprivation and provision of acute and long-term care after stroke: the South London Stroke Register cohort study. J Neurol Neurosurg Psychiatry. 2014;85:1294–300.CrossRef
32.
Sjolander M, Eriksson M, Glader EL. Social stratification in the dissemination of statins after stroke in Sweden. Eur J Clin Pharmacol. 2013;69:1173–80.CrossRef
33.
Sjolander M, Eriksson M, Asplund K, Norrving B, Glader EL. Inequalities in the Prescription of Oral Anticoagulants in Stroke Patients With Atrial Fibrillation. Stroke. 2015;46:2220–5.CrossRef
34.
Sjolander M, Eriksson M, Glader EL. Inequalities in medication adherence to statin treatment after stroke: A nationwide observational study. Eur Stroke J. 2016;1:101–7.CrossRef
35.
36.
37.
Friis K, Lasgaard M, Osborne RH, Maindal HT. Gaps in understanding health and engagement with healthcare providers across common long-term conditions: a population survey of health literacy in 29,473 Danish citizens. BMJ Open. 2016;6:e009627.CrossRef
38.
Miller TA. Health literacy and adherence to medical treatment in chronic and acute illness: A meta-analysis. Patient Educ Couns. 2016;99:1079–86.CrossRef
Metadata
Title
Nurse-led, telephone-based secondary preventive follow-up benefits stroke/TIA patients with low education: a randomized controlled trial sub-study
Authors
Anna-Lotta Irewall
Joachim Ögren
Lisa Bergström
Katarina Laurell
Lars Söderström
Thomas Mooe
Publication date
01-12-2019
Publisher
BioMed Central
Keyword
Stroke
Published in
Trials / Issue 1/2019
Electronic ISSN: 1745-6215
DOI
https://doi.org/10.1186/s13063-018-3131-4

Other articles of this Issue 1/2019

Trials 1/2019 Go to the issue

Research

Synthesizing existing evidence to design future trials: survey of methodologists from European institutions

Study protocol

Promoting Help-seeking using E-technology for ADolescents with mental health problems: study protocol for a randomized controlled trial within the ProHEAD Consortium

Study protocol

Probiotics in pregnancy: protocol of a double-blind randomized controlled pilot trial for pregnant women with depression and anxiety (PIP pilot trial)

Update

Detailed statistical analysis plan for the Dutch STRIDER (Sildenafil TheRapy In Dismal prognosis Early-onset fetal growth Restriction) randomised clinical trial on sildenafil versus placebo for pregnant women with severe early onset fetal growth restriction

Study protocol

Oleogel-S10 Phase 3 study “EASE” for epidermolysis bullosa: study design and rationale

Research

Pragmatic randomised trial of a smartphone app (NRT2Quit) to improve effectiveness of nicotine replacement therapy in a quit attempt by improving medication adherence: results of a prematurely terminated study