Stroke health management: Novel strategies for the prevention of recurrent ischemic stroke

Lili Jiang; Yu Zhou; Li Zhang; Lingling Wu; Haibin Shi; Bin He; Yao Wang; Qianghui Liu; Xueli Ji; Xintong Zhang; Lei Jiang; Hao Sun

doi:10.3389/fneur.2022.1018794

Stroke health management: Novel strategies for the prevention of recurrent ischemic stroke

Front Neurol. 2022 Oct 26:13:1018794. doi: 10.3389/fneur.2022.1018794. eCollection 2022.

Authors

Lili Jiang¹, Yu Zhou¹, Li Zhang¹, Lingling Wu², Haibin Shi², Bin He¹, Yao Wang¹, Qianghui Liu¹, Xueli Ji¹, Xintong Zhang³, Lei Jiang¹, Hao Sun¹

Affiliations

¹ Department of Emergency, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China.
² Department of Interventional Radiography, The First Affiliated Hospital With Nanjing Medical University, Nanjing, China.
³ Department of Rehabilitation Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China.

Abstract

Objectives: The aim of the study was to assess the effect of the stroke health management model on the prognosis and recurrence of mild to moderate ischemic stroke, guided by the stroke health manager based on the patients' needs. In addition, up-to-date evidence of healthcare resource allocation, planning, and optimization is provided.

Methods: The current research was a retrospective, observational, single-center, history-controlled study with patients divided into two groups, namely, the intervention group and the control group, following the guidance of the stroke health manager. The control group patients received standard medical care during hospitalization, which consisted of advice on healthy lifestyle choices carried out by the bed nurse, but no structured education, WeChat group, or clinical consultation was included. The intervention group patients, in addition to the standard medical care, received health management and health education from the stroke health manager, and after hospital discharge, the patients were followed up over the telephone by the health manager to see if there was any recurrence or readmission.

Results: From 1 January 2018 to 31 December 2020, 382 patients with acute ischemic stroke were enrolled in this study. Through the univariate regression analysis, we found that SHM intervention was associated with a significantly lower risk of recurrence (HR = 0.459). We constructed a nomogram based on the significant variables from the regression analysis and also analyzed the association between the control group and the SHM intervention group among all subgroups using the Cox proportional hazards model to assess the effect of the stroke health management model. Most patients in this study had a total risk point between 170 and 270. The C-index value was 0.76, and the time-dependent AUC for predicting recurrence was >0.7.

Conclusion: The stroke health manager-guided management model based on patients' needs can better control the risk factors of stroke and significantly reduce the recurrence rate of mild to moderate ischemic stroke within 1 year.

Keywords: follow-up; health management; ischemic stroke; recurrence; stroke health manager.