Effects of a Disease Management Program for Preventing Recurrent Ischemic Stroke

• Published in: Stroke (1970) 2019-03, Vol.50 (3), p.705-712
• Main Authors: Fukuoka, Yasuko, Hosomi, Naohisa, Hyakuta, Takeshi, Omori, Toyonori, Ito, Yasuhiro, Uemura, Jyunichi, Yagita, Yoshiki, Kimura, Kazumi, Matsumoto, Masayasu, Moriyama, Michiko
• Format: Article
• Language: English
• ISSN: 1524-4628
• DOI: 10.1161/strokeaha.118.020888

Background and Purpose- Disease management is a healthcare strategy that includes self-management education and treatment coordination. We conducted a randomized controlled trial to determine whether a disease management program intervention could improve risk factor profiles and, thus, reduce the recurrence of stroke and other cardiovascular diseases. Methods- This study is a prospective randomized, open-label, parallel group study involving outpatients with a history of stroke. Between September 2010 and November 2012, we enrolled patients aged between 40 and 80 years who experienced their last ischemic stroke event or transient ischemic attack within 1 year. After stratifying by the ischemic stroke subtype, 321 subjects (67.5±8.5 years, 95 female) were randomly assigned to either the disease management program intervention group (n=156) or the usual care group (n=165). The primary end point of this study was the difference in the Framingham risk score (general cardiovascular disease 10-year risk) from baseline. The secondary end points of this study included stroke recurrence, onset of cardiovascular disease, all-cause mortality, and all vascular events. Results- Regarding the primary end point, there was no significant difference in the changes in the Framingham risk score at any follow-up time between the groups. The incidence of stroke recurrence tended to be lower in the disease management program intervention group, although no significant difference was found (hazard ratio, 0.49; 95% CI, 0.19-1.29). Conclusions- We were unable to demonstrate a clear benefit of disease management program intervention. Clinical Trial Registration- URL: https://www.clinicaltrials.gov . Unique identifier: NCT02121327.