From the Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health (M.T.O., D.A.C., J.K., V.K.S., T.P., A.G.T.) and Department of Epidemiology and Preventive Medicine (M.R.N., S.M.F.), Monash University, Clayton, Victoria, Australia; Stroke Division, Florey Institute of Neuroscience and Mental Health, Heidelberg, Victoria, Australia (D.A.C., J.K.); Menzies Institute for Medical Research, Hobart, Tasmania, Australia (M.R.N., V.K.S.); Department of Medicine, Epworth Healthcare, Richmond, Victoria, Australia (R.P.G.); Department of Neurosciences, Box Hill Hospital, Victoria, Australia (C.F.B.); and Department of Neurology, Alfred Hospital, Melbourne, Victoria, Australia (J.F.).
Stroke. 2017 Sep;48(9):2504-2510. doi: 10.1161/STROKEAHA.117.017499. Epub 2017 Jul 28.
Many guidelines for secondary prevention of stroke focus on controlling cardiometabolic risk factors. We investigated the effectiveness of a management program for attaining cardiometabolic targets in survivors of stroke/transient ischemic attack.
Randomized controlled trial of survivors of stroke/transient ischemic attack aged ≥18 years. General practices were randomized to usual care (control) or an intervention comprising specialist review of care plans and nurse education in addition to usual care. The outcome is attainment of pre-defined cardiometabolic targets based on Australian guidelines. Multivariable regression was undertaken to determine efficacy and identify factors associated with attaining targets.
Overall, 283 subjects were randomized to the intervention and 280 to controls. Although we found no between-group difference in overall cardiometabolic targets achieved at 12 months, the intervention group more often achieved control of low-density lipoprotein cholesterol (odds ratio, 1.97; 95% confidence interval, 1.18-3.29) than controls. At 24 months, no between-group differences were observed. Medication adherence was ≥80% at follow-up, but uptake of lifestyle/behavioral habits was poor. Older age, being male, being married/living with partner, and having greater functional ability or a history of diabetes mellitus were associated with attaining targets.
The intervention in this largely negative trial only had a detectable effect on attaining target for lipids but not for other factors at 12 months or any factor at 24 months. This limited effect may be attributable to inadequate uptake of behavioral/lifestyle interventions, highlighting the need for new or better approaches to achieve meaningful behavioral change.
URL: http://www.clinicaltrials.gov. Unique identifier: ACTRN12608000166370.
许多针对中风二级预防的指南都侧重于控制心脏代谢风险因素。我们研究了一种针对中风/短暂性脑缺血发作幸存者实现心脏代谢目标的管理方案的有效性。
对年龄≥18 岁的中风/短暂性脑缺血发作幸存者进行随机对照试验。普通诊所被随机分为常规护理（对照组）或干预组，干预组除了常规护理外，还包括对护理计划进行专家审查和护士教育。结局是根据澳大利亚指南达到预先定义的心脏代谢目标。采用多变量回归确定疗效，并确定与达到目标相关的因素。
共有 283 名受试者被随机分配到干预组，280 名受试者被随机分配到对照组。尽管我们在 12 个月时未发现两组之间总体心脏代谢目标的达成情况存在差异，但干预组比对照组更常达到控制低密度脂蛋白胆固醇的目标（比值比，1.97；95%置信区间，1.18-3.29）。在 24 个月时，未观察到两组之间的差异。随访时药物依从性≥80%，但生活方式/行为习惯的采用率较差。年龄较大、男性、已婚/与伴侣同住、功能能力较强或有糖尿病史与达到目标相关。
在这项主要为阴性的试验中，干预措施仅在 12 个月时对达到脂质目标有可检测的效果，但在 24 个月时对任何因素都没有效果。这种有限的效果可能归因于行为/生活方式干预的采用不足，这突显了需要新的或更好的方法来实现有意义的行为改变。
