Finlay A McAlister1, Steven Grover2, Raj S Padwal3, Erik Youngson4, Miriam Fradette5, Ann Thompson6, Brian Buck7, Naeem Dean8, Ross T Tsuyuki9, Ashfaq Shuaib10, Sumit R Majumdar11. 1. Division of General Internal Medicine, University of Alberta, Edmonton, Alberta, Canada; Patient Health Outcomes Research and Clinical Effectiveness Unit, University of Alberta, Edmonton, Alberta, Canada; The Epidemiology Coordinating and Research Centre, University of Alberta, Edmonton, Alberta, Canada. Electronic address: finlay.mcalister@ualberta.ca. 2. McGill Cardiovascular Health Improvement Program, Division of General Internal Medicine, McGill University, Montreal, Canada. Electronic address: steven.grover@mcgill.ca. 3. Division of General Internal Medicine, University of Alberta, Edmonton, Alberta, Canada. Electronic address: rpadwal@ualberta.ca. 4. Patient Health Outcomes Research and Clinical Effectiveness Unit, University of Alberta, Edmonton, Alberta, Canada. Electronic address: erik.youngson@ualberta.ca. 5. The Epidemiology Coordinating and Research Centre, University of Alberta, Edmonton, Alberta, Canada. Electronic address: miriam.fradette@ualberta.ca. 6. Faculty of Pharmacy and Pharmaceutical Sciences, University of Alberta, Edmonton, Alberta, Canada. Electronic address: athompson@ualberta.ca. 7. Division of Neurology, University of Alberta, Edmonton, Alberta, Canada; Division of Neurology, Grey Nuns Hospital, Edmonton, Canada. 8. Division of Internal Medicine, Royal Alexandra Hospital, Edmonton, Canada; Division of Neurology, University of Alberta, Edmonton, Alberta, Canada. Electronic address: Naeem.Dean@capitalhealth.ca. 9. The Epidemiology Coordinating and Research Centre, University of Alberta, Edmonton, Alberta, Canada. Electronic address: ross.tsuyuki@ualberta.ca. 10. Division of Neurology, University of Alberta, Edmonton, Alberta, Canada. Electronic address: ashfaq.shuaib@ualberta.ca. 11. Division of General Internal Medicine, University of Alberta, Edmonton, Alberta, Canada. Electronic address: me2.majumdar@ualberta.ca.
Abstract
BACKGROUND: Survivors of ischemic stroke/transient ischemic attack (TIA) are at high risk for other vascular events. We evaluated the impact of 2 types of case management (hard touch with pharmacist or soft touch with nurse) added to usual care on global vascular risk. METHODS: This is a prespecified secondary analysis of a 6-month trial conducted in outpatients with recent stroke/TIA who received usual care and were randomized to additional monthly visits with either nurse case managers (who counseled patients, monitored risk factors, and communicated results to primary care physicians) or pharmacist case managers (who were also able to independently prescribe according to treatment algorithms). The Framingham Risk Score [FRS]) and the Cardiovascular Disease Life Expectancy Model (CDLEM) were used to estimate 10-year risk of any vascular event at baseline, 6 months (trial conclusion), and 12 months (6 months after last trial visit). RESULTS:Mean age of the 275 evaluable patients was 67.6 years. Both study arms were well balanced at baseline and exhibited reductions in absolute global vascular risk estimates at 6 months: median 4.8% (Interquartile range (IQR) 0.3%-11.3%) for the pharmacist arm versus 5.1% (IQR 1.9%-12.5%) for the nurse arm on the FRS (P = .44 between arms) and median 10.0% (0.1%-31.6%) versus 12.5% (2.1%-30.5%) on the CDLEM (P = .37). These reductions persisted at 12 months: median 6.4% (1.2%-11.6%) versus 5.5% (2.0%-12.0%) for the FRS (P = .83) and median 8.4% (0.1%-28.3%) versus 13.1% (1.6%-31.6%) on the CDLEM (P = .20). CONCLUSIONS: Case management by nonphysician providers is associated with improved global vascular risk in patients with recent stroke/TIA. Reductions achieved during the active phase of the trial persisted after trial conclusion.
RCT Entities:
BACKGROUND: Survivors of ischemic stroke/transient ischemic attack (TIA) are at high risk for other vascular events. We evaluated the impact of 2 types of case management (hard touch with pharmacist or soft touch with nurse) added to usual care on global vascular risk. METHODS: This is a prespecified secondary analysis of a 6-month trial conducted in outpatients with recent stroke/TIA who received usual care and were randomized to additional monthly visits with either nurse case managers (who counseled patients, monitored risk factors, and communicated results to primary care physicians) or pharmacist case managers (who were also able to independently prescribe according to treatment algorithms). The Framingham Risk Score [FRS]) and the Cardiovascular Disease Life Expectancy Model (CDLEM) were used to estimate 10-year risk of any vascular event at baseline, 6 months (trial conclusion), and 12 months (6 months after last trial visit). RESULTS: Mean age of the 275 evaluable patients was 67.6 years. Both study arms were well balanced at baseline and exhibited reductions in absolute global vascular risk estimates at 6 months: median 4.8% (Interquartile range (IQR) 0.3%-11.3%) for the pharmacist arm versus 5.1% (IQR 1.9%-12.5%) for the nurse arm on the FRS (P = .44 between arms) and median 10.0% (0.1%-31.6%) versus 12.5% (2.1%-30.5%) on the CDLEM (P = .37). These reductions persisted at 12 months: median 6.4% (1.2%-11.6%) versus 5.5% (2.0%-12.0%) for the FRS (P = .83) and median 8.4% (0.1%-28.3%) versus 13.1% (1.6%-31.6%) on the CDLEM (P = .20). CONCLUSIONS: Case management by nonphysician providers is associated with improved global vascular risk in patients with recent stroke/TIA. Reductions achieved during the active phase of the trial persisted after trial conclusion.
Authors: Raj S Padwal; Helen So; Peter W Wood; Finlay A Mcalister; Muzaffar Siddiqui; Colleen M Norris; Tom Jeerakathil; James Stone; Shelley Valaire; Balraj Mann; Pierre Boulanger; Scott W Klarenbach Journal: J Clin Hypertens (Greenwich) Date: 2018-12-20 Impact factor: 3.738
Authors: Bernadeta Bridgwood; Kate E Lager; Amit K Mistri; Kamlesh Khunti; Andrew D Wilson; Priya Modi Journal: Cochrane Database Syst Rev Date: 2018-05-07
Authors: Thomas Toell; Christian Boehme; Lukas Mayer; Stefan Krebs; Clemens Lang; Karin Willeit; Barbara Prantl; Michael Knoflach; Gerhard Rumpold; Gudrun Schoenherr; Andrea Griesmacher; Peter Willeit; Julia Ferrari; Wilfried Lang; Stefan Kiechl; Johann Willeit Journal: BMC Neurol Date: 2018-11-06 Impact factor: 2.474
Authors: Heidrun Golla; Kim Dillen; Martin Hellmich; Thomas Dojan; Solveig Ungeheuer; Petra Schmalz; Angelika Staß; Vanessa Mildenberger; Yasemin Goereci; Veronika Dunkl; Julia Strupp; Gereon R Fink; Raymond Voltz; Stephanie Stock; Oliver Cornely; Alexander Stahmann; Anne Müller; Peter Löcherbach; Lothar Burghaus; Volker Limmroth; Eckhard Bonmann; Kathrin Gerbershagen; Gereon Nelles; Thomas Joist; Judith Haas; Herbert Temmes; Clemens Warnke Journal: BMJ Open Date: 2022-01-25 Impact factor: 2.692