Case management-based post-stroke care for patients with acute stroke and TIA (SOS-Care): a prospective cohort study

Abstract

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.

Keywords: Post-stroke care; Secondary stroke prevention; Stroke recurrence; Vascular mortality.

Fig. 1

Study flow diagram

Fig. 2

Kaplan–Meier curves for the primary outcome. Kaplan-Meier curves for the cumulative probability of the primary outcome (composite of stroke, TIA or vascular death) for the entire study population (A) and for patients whose qualifying event was an ischemic stroke (B)

Fig. 3

Vascular risk factor control among SOS-Care patients. *p < 0.05 after Holm-Bonferroni correction for pair-wise comparisons, using the 3-month time point as reference; **p < 0.05 after Holm-Bonferroni correction for pair-wise comparisons, using the 6-month time point as reference. ^§based on 866 patients;^†based on 755 patients; ^‖based on 451 patients; ^‡based on 464 patients; ^$based on 756 patients; ^‡‡based on 817 patients