Embargoed until 4:00 a.m. CT / 5:00 a.m. ET Thursday, February 3, 2022
NEW ORLEANS, February 3, 2022 — A new strategy using telehealth to monitor blood pressure at home for several months immediately following a stroke has had a positive impact on patient engagement and blood pressure control in people who live in historically underresourced communities, according to preliminary research to be presented at the American Stroke Association’s 2022 International Stroke Conference, a premier global meeting for researchers and clinicians dedicated to the science of Stroke and Brain Health to be held in person in New Orleans, and virtually, February 8-11, 2022.
An ischemic stroke (caused by a blocked blood vessel leading to the brain) greatly increases the risk of having another stroke. It is important to prevent a second stroke because the risk of serious disability increases dramatically with each additional stroke.
“Hypertension is the single most important modifiable risk factor for a second or recurrent stroke. We know that a small change to lower systolic blood pressure [the top number in a blood pressure reading] reduces the risk of recurrent stroke by more than 20%. Yet blood pressure is poorly controlled in more than half of stroke survivors,” said study lead author Imama A. Naqvi, MD, assistant professor of neurology at Columbia University Vagelos College of Physicians. and Surgeons and neurologist in New York. Presbyterian/Columbia University Irving Medical Center, both in New York. “We also know that black adults have a higher prevalence of uncontrolled blood pressure. Additionally, black and Hispanic populations have a higher risk of stroke, and the greatest increase in stroke prevalence is expected to occur among Hispanic men.
In this feasibility study, Columbia University researchers tested the potential impact of a new multidisciplinary strategy called Telehealth After Stroke Care (TASC) for stroke survivors who received post-stroke care in NewYork-Presbyterian/Columbia University Irving Medical Center. The study took place in the northern Manhattan area, with an underserved community. Participants included 50 stroke survivors (44% were Hispanic adults; 32% black adults and 20% white adults), with an average age of 64 years. About half (54%) of participants had been through high school, and 30% had private health insurance. They were randomly divided into two groups: half of the study participants received usual care (the control group); the other half of study participants experienced improved telehealth after their stroke (the intervention group). Both groups were enrolled before hospital discharge and followed for 90 days, the window of time when the risk of having another stroke is highest.
Patients assigned to the control group had a videoconference appointment with a primary care professional one to two weeks after hospital discharge, and videoconference appointments with a stroke specialist at 6 and 12 weeks after release. Participants in the enhanced telehealth group received mobile tablets, blood pressure monitors, and video visits with a multidisciplinary team, including pharmacy support. The home blood pressure monitor remotely sent the participant’s readings to the patient’s electronic health record. Based on these remote readings, a nurse provided telephone support and could escalate to telepharmacists and doctors, if necessary. The enhanced telehealth group also received a plain language blood pressure infographic in English or Spanish, specifically tailored to their individual health information, to help educate them about healthy blood pressure levels, goals and ways to improve their blood pressure. Home blood pressure was measured at the end of the study.
Key findings of the study included:
- The post-stroke telehealth strategy significantly improved patient follow-up: 84% of patients in the enhanced telehealth group completed the 12-week study, compared to 64% of patients in the usual care group.
- 91% of patients in the enhanced telehealth group completed the video visit with primary care professionals and specialists, compared to 75% of patients in the usual care group.
- Blood pressure control was better in the enhanced telehealth group at 76% compared to 25% control in the control group.
- Among black study participants, blood pressure control increased from 40% of participants at enrollment to 100% at study end in the enhanced telehealth group and improved only by 14% to 29% in the control group.
“COVID-19 has exposed many health inequities that make post-stroke care more difficult and have created a gap in health outcomes for people from diverse racial and ethnic groups. We need to find ways to bridge this gap,” Naqvi said. “Mobile health tools such as wireless blood pressure monitors that enable remote monitoring are here to stay, and we need to find ways to use telemedicine to improve care for all stroke survivors. As physicians, we want to provide patients with equitable access to care and find the right stroke care interventions that engage patients and improve health outcomes.”
The researchers urge caution in interpreting the results of this feasibility study; although promising, these results warrant further replication in a larger trial.
“This new research will continue to strengthen our work and commitment to addressing health inequities, focusing on blood pressure through regular remote monitoring and in partnership with our patients,” said Willie Lawrence, MD. , chair of the American Heart Association’s National Hypertension Control Initiative Surveillance. Committee. “The goal of the National Hypertension Control Initiative is to improve rates of blood pressure control in historically disadvantaged communities. By applying a multi-faceted approach that includes comprehensive training and technical assistance for community health center professionals, collaboration with trusted community organizations, and direct patient education, we hope to empower communities to get blood pressure education and resources that can improve outcomes before a stroke occurs, as well as create a network of post-stroke care and support.
The study’s co-authors are Kevin H. Strobino, MPH; Kevin Schmitt, MS; Jessica Li; Hanlin Li, Doctor of Pharmacy, MBA; Mary Boy, NP; Sarah Tom, Ph.D., MPH; Adriana Arcia, Ph.D., RN; Olajide A. Williams, MD, MS; Ken Cheung, Ph.D.; Ian M. Kronish, MD, MPH; and Mitchell S. Elkind, MD, MS A list of author disclosures is available in the abstract.
Statements and conclusions of studies presented at American Stroke Association and American Heart Association scientific meetings are solely those of the study authors and do not necessarily reflect the policy or position of the Association. The Association makes no representations or warranties as to their accuracy or reliability. Abstracts presented at the Association’s Scientific Meetings are not peer-reviewed, but rather by independent review committees and are considered based on the potential to add to the diversity of scientific issues and viewpoints discussed. during a meeting. Results are considered preliminary until published as a full manuscript in a peer-reviewed scientific journal.
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The American Stroke Association’s International Stroke Conference (ISC) is the premier global meeting devoted to the science and treatment of stroke disease. ISC 2022 will be held in-person in New Orleans and virtually, February 8-11, 2022. The three-day conference will feature more than 1,500 compelling presentations in 17 categories that focus on basic, clinical, and translational sciences at as research moves towards a better understanding of stroke pathophysiology with the goal of developing more effective therapies. Participate in the international stroke conference on social media via #ISC22.
About the American Stroke Association
The American Stroke Association is dedicated to saving people from strokes – the second leading cause of death worldwide and one of the leading causes of severe disability. We team up with millions of volunteers to fund innovative research, fight for stronger public health policies, and provide vital tools and information to prevent and treat stroke. The Dallas-based association was officially launched in 1998 as a division of the American Heart Association. Join us on stroke.org, Facebook, Twitter or by calling 1-888-4STROKE.
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