Improved Risk Factor Control Through a Transitional Care Program for Stroke Survivors
Overview
- Phase
- N/A
- Intervention
- Not specified
- Conditions
- Stroke, Ischemic
- Sponsor
- Syntrillo, Inc
- Enrollment
- 224
- Locations
- 1
- Primary Endpoint
- Increased compliance with therapeutic standards of care according to the American Heart Association (AHA) guidelines for secondary stroke prevention in early vs late group
- Status
- Recruiting
- Last Updated
- 11 months ago
Overview
Brief Summary
The goal of this clinical trial is to evaluate whether our transitional care program helps stroke survivors better manage their risk factors for stroke to lower the risk of a repeat stroke. The main question it aims to answer is:
- Does the program help participants meet the targets set by the American Heart Association clinical guidelines for control of risk factors associated with stroke?
Researchers will compare participants enrolled right after being discharged from the hospital to participants enrolled around 3-5 months after being discharged to examine whether timing differences in enrollment affect the efficacy of the program.
Participants will:
- Keep track of their medications, their exercise, and their health information using smart devices provided by the study
- Answer questions about their health and lifestyle
- Meet with our team of healthcare providers
Investigators
Eligibility Criteria
Inclusion Criteria
- •All Cohorts:
- •Age 30 or above
- •Evidence of ischemic stroke documented on CT or MRI
- •Modified Rankin score of 3 or less
- •Early Enrollment:
- •Admission for ischemic stroke at a participating site
- •Enrolled during their admission for ischemic stroke or within 24 hours of discharge
- •Late Enrollment:
- •Stroke survivors previously admitted at the participating sites' inpatient stroke unit
- •Enrollment date between 1 and 6 months after discharge for inpatient admission for ischemic stroke
Exclusion Criteria
- •Participants determined to have hemorrhagic or periprocedural stroke based on hospital EMR review will be excluded.
- •Participants determined to have an ischemic stroke due to dissection based on hospital EMR review will be excluded.
- •Participants who lack capacity determined by the care team during their hospitalization (for the early enrollment group) or their most recent clinical encounter (for the late enrollment group) will be excluded.
- •Participants with a diagnosis of dementia will be excluded.
- •Participants with acute subdural hemorrhage will be excluded.
- •Participants with hemorrhagic stroke due to vascular abnormality (aneurysm or AVM) or trauma will be excluded.
- •Participants who cannot perform the following will be excluded:
- •offer a consistent choice about participating in the study
- •demonstrate that they can comprehend and recall major features of the study including: participation is voluntary, the major procedures, the primary risk, and the primary benefit.
- •Participants who are discharged to Long-term Acute Care Hospitals will be excluded.
Outcomes
Primary Outcomes
Increased compliance with therapeutic standards of care according to the American Heart Association (AHA) guidelines for secondary stroke prevention in early vs late group
Time Frame: From enrollment to the end of the 6 month monitoring period
We will measure percent compliance with AHA therapeutic standards in the early enrollment group compared to the anticipated baseline percent compliance in the late enrollment group at equivalent time points post-discharge. Percent compliance is a composite endpoint. Participants will be considered "compliant" to secondary stroke prevention guidelines if all other conditions below (2-5) are met. Participants will be considered "non-compliant" to secondary stroke prevention guidelines if one or more conditions are not met.
90% of systolic blood pressure (SBP) readings < 130 mmHg AND 90% of diastolic blood pressure (DBP) readings < 80 mmHg in a one week period
Time Frame: From enrollment to the end of the 6 month monitoring period
Blood pressure will be measured using Tenovi's FDA-cleared, portable home blood pressure monitoring device. Both systolic and diastolic measurements must be below the threshold in order for the condition to be met.
Moderate intensity activity > 150 minutes per week on average
Time Frame: From enrollment to the end of the 6 month monitoring period
Physical activity will be assessed through a combination of self-reported and biometric data. We will administer a physical activity questionnaire and correlate self-reported activity with biometric data obtained from the smartwatch to estimate physical activity and assess confidence level in the data.
Correct prescription of antiplatelet, anticoagulant, and statin medications per guidelines when no contraindications are present
Time Frame: From enrollment to the end of the 6 month monitoring period
We will verify correct prescriptions and dosing through EHR records, pharmacy records, and/or patient self-report as applicable. Correct prescription and dosing will be determined through expert opinion following AHA therapeutic standards.
Adherence of antiplatelet, anticoagulant, and statin medications > 90%
Time Frame: From enrollment to the end of the 6 month monitoring period
Adherence is determined by percent of missed doses per week. Medication adherence will be monitored through a combination of self-report, device data, and pharmacy records, as applicable. We will administer the 5-Item Medication Adherence Report Scale (MARS-5) and correlate self-reported data with device data from Tenovi's smart pillbox and pharmacy records to estimate percent adherence and assess confidence level in the data.
Secondary Outcomes
- Average change in compliance percentage at 1, 2, and 3 months following initiation of our transitional care program(From enrollment to the end of the 6 month monitoring period)
- Frequency of recurrent stroke in the early enrollment cohort compared to the late enrollment cohort at equivalent time points post-discharge(From enrollment to the end of the 6 month monitoring period)
- Frequency of readmission in the in the early enrollment cohort compared to the late enrollment cohort at equivalent time points post-discharge(From enrollment to the end of the 6 month monitoring period)