Derivation and Application of a Tool to Estimate Benefits From Multiple Therapies That Reduce Recurrent Stroke Risk

Autor: Ning Li, Amytis Towfighi, Eric M. Cheng, Robert Bryg, Nerses Sanossian, Frances Barry, Adam K. Richards, Nicholas Jackson, Arleen F. Brown, Barbara G. Vickrey
Rok vydání: 2020
Předmět:
Relative risk reduction
Male
medicine.medical_treatment
Original Contributions
Psychological intervention
Cardiorespiratory Medicine and Haematology
Cardiovascular
law.invention
Randomized controlled trial
law
Recurrence
Secondary Prevention
Medicine
Stroke
outcome assessment health care
Anticholesteremic Agents
Health services research
Middle Aged
Prognosis
stroke
health services research
ComputingMethodologies_DOCUMENTANDTEXTPROCESSING
Female
Cardiology and Cardiovascular Medicine
medicine.medical_specialty
Clinical Trials and Supportive Activities
Clinical Sciences
Clinical Research
Humans
cardiovascular diseases
Risk factor
Intensive care medicine
Exercise
Antihypertensive Agents
Aged
Advanced and Specialized Nursing
Neurology & Neurosurgery
Aspirin
business.industry
Prevention
Neurosciences
Anticoagulants
medicine.disease
Brain Disorders
Relative risk
Smoking cessation
Smoking Cessation
Neurology (clinical)
Warfarin
Hydroxymethylglutaryl-CoA Reductase Inhibitors
business
Risk Reduction Behavior
Platelet Aggregation Inhibitors
Diet Therapy
Zdroj: Stroke, vol 51, iss 5
Stroke
ISSN: 0086-1081
Popis: Supplemental Digital Content is available in the text.
Background and Purpose— Lowering blood pressure and cholesterol, antiplatelet/antithrombotic use, and smoking cessation reduce risk of recurrent stroke. However, gaps in risk factor control among stroke survivors warrant development and evaluation of alternative care delivery models that aim to simultaneously improve multiple risk factors. Randomized trials of care delivery models are rarely of sufficient duration or size to be powered for low-frequency outcomes such as observed recurrent stroke. This creates a need for tools to estimate how changes across multiple stroke risk factors reduce risk of recurrent stroke. Methods— We reviewed existing evidence of the efficacy of interventions addressing blood pressure reduction, cholesterol lowering, antiplatelet/antithrombotic use, and smoking cessation and extracted relative risks for each intervention. From this, we developed a tool to estimate reductions in recurrent stroke risk, using bootstrapping and simulation methods. We also calculated a modified Global Outcome Score representing the proportion of potential benefit (relative risk reduction) achieved if all 4 individual risk factors were optimally controlled. We applied the tool to estimate stroke risk reduction among 275 participants with complete 12-month follow-up data from a recently published randomized trial of a healthcare delivery model that targeted multiple stroke risk factors. Results— The recurrent stroke risk tool was feasible to apply, yielding an estimated reduction in the relative risk of ischemic stroke of 0.36 in both the experimental and usual care trial arms. Global Outcome Score results suggest that participants in both arms likely averted, on average, 45% of recurrent stroke events that could possibly have been prevented through maximal implementation of interventions for all 4 individual risk factors. Conclusions— A stroke risk reduction tool facilitates estimation of the combined impact on vascular risk of improvements in multiple stroke risk factors and provides a summary outcome for studies testing alternative care models to prevent recurrent stroke. Registration— URL: https://www.clinicaltrials.gov; Unique identifier: NCT00861081.
Databáze: OpenAIRE
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