背景:卒中复发的高发生率需要有效的卒中后护理。这项研究调查了基于病例管理的卒中后护理计划在急性卒中和TIA患者中的有效性。
方法:在这项前瞻性队列研究中,TIA患者,缺血性卒中或脑出血纳入一项为期12个月的基于病例管理的项目(SOS-Care),同时纳入常规治疗.对照患者仅接受常规护理。该计划包括案件经理的家庭和电话咨询,注重教育,医疗和社会需求以及基于指南的二级预防。主要结局是12个月后卒中复发和血管性死亡的复合。次要结果包括12个月时的血管危险因素控制。
结果:从2011年11月至2020年12月,1109例患者(17.9%的TIA,77.5%缺血性卒中,纳入4.6%的脑出血)。在85(7.7%)辍学后,925名SOS-Care患者与99名对照进行比较分析。基线特征相似,除了中风后护理中男性较少,血脂异常病史较少。12个月时,与对照组相比,卒中后护理与复合终点的减少相关(4.9vs.14.1%;HR0.30,95%CI0.16-0.56,p<0.001),仅缺血性卒中患者的结果一致(HR0.32,95%CI0.17-0.61,p<0.001)。中风后护理更频繁地实现高血压的治疗目标,血脂异常,糖尿病,BMI与二级预防用药依从性(p<0.05)。
结论:基于病例管理的卒中后护理可有效降低未选择的卒中患者的血管事件风险。这些发现可以指导未来的随机试验,调查基于病例管理的模型在卒中后护理中的功效。
BACKGROUND: The high incidence of stroke recurrence necessitates effective post-stroke care. This study investigates the effectiveness of a
case management-based post-stroke care program in patients with acute stroke and TIA.
METHODS: In this prospective cohort study, patients with TIA, ischemic stroke or intracerebral hemorrhage were enrolled into a 12-month
case management-based program (SOS-Care) along with conventional care. Control patients received only conventional care. The program included home and phone consultations by
case managers, focusing on education, medical and social needs and guideline-based secondary prevention. The primary outcome was the composite of stroke recurrence and vascular death after 12 months. Secondary outcomes included vascular risk factor control at 12 months.
RESULTS: From 11/2011 to 12/2020, 1109 patients (17.9% TIA, 77.5% ischemic stroke, 4.6% intracerebral hemorrhage) were enrolled. After 85 (7.7%) dropouts, 925 SOS-Care patients remained for comparative analysis with 99 controls. Baseline characteristics were similar, except for fewer males and less frequent history of dyslipidemia in post-stroke care. At 12 months, post-stroke care was associated with a reduction in the composite endpoint compared to controls (4.9 vs. 14.1%; HR 0.30, 95% CI 0.16-0.56, p < 0.001), with consistent results in ischemic stroke patients alone (HR 0.32, 95% CI 0.17-0.61, p < 0.001). Post-stroke care more frequently achieved treatment goals for hypertension, dyslipidemia, diabetes, BMI and adherence to secondary prevention medication (p < 0.05).
CONCLUSIONS: Case management-based post-stroke care may effectively mitigate the risk of vascular events in unselected stroke patients. These findings could guide future randomized trials investigating the efficacy of
case management-based models in post-stroke care.