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J Stroke Cerebrovasc Dis. 2014 Oct;23(9):2287-95. doi: 10.1016/j.jstrokecerebrovasdis.2014.04.021. Epub 2014 Jul 19.

Secondary prevention and health promotion after stroke: can it be enhanced?

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Department of Health Sciences, Lund University, Lund, Sweden. Electronic address:
Department of Laboratory Medicine, Clinical Chemistry and Pharmacology, Lund University, Lund, Sweden.
Department of Neurology, Skåne University Hospital, Malmö, Sweden.


The aim was to study if health outcome and secondary prevention were satisfactory 1 year after stroke and if nurse-led interventions 3 months after stroke could have impact. Design was a randomized controlled open trial in a 1-year population. Primary outcome was health status 1 year after stroke. One month after stroke, survivors were randomized into intervention group (IG) with follow-up by a specialist nurse (SN) after 3 months (n = 232), and control group (CG) with standard care (n = 227), all to be followed up 1 year after stroke. At the first follow-up, patients graded their health, replied to the EuroQol-5 Dimensions (EQ-5D) health outcome questions, health problems were assessed, and supportive counseling was provided in the IG. Health problems requiring medical interventions were primarily referred to a general practitioner (GP). One year after stroke, 391 survivors were followed up. Systolic blood pressure (BP) had decreased in IG (n = 194) from median 140 to 135 (P = .05), but about half were above the limit 139 in both groups. A larger proportion (22%) had systolic BP >155 in the CG (n = 197) than in the IG (14%; P = .05). In the IG, 62% needed referrals compared with the 75% in the CG (P = .009). Forty percent in the IG and 52.5% in the CG (P = .04) reported anxiety/depression. In the IG, 75% and 67% in the CG rated their general health as fairly good or very good (P = .05). Although nurse-led interventions could have some effect, the results were not optimal. A more powerful strategy could be closer collaboration between the SN and a stroke clinician, before referring to primary care.


Health promotion; nurse's role; referral and consultation; risk factors; secondary prevention; stroke

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