scholarly journals Mobile health as a viable strategy to enhance stroke risk factor control: A systematic review and meta-analysis

2017 ◽  
Vol 378 ◽  
pp. 140-145 ◽  
Author(s):  
Shimeng Liu ◽  
Wuwei Feng ◽  
Pratik Y. Chhatbar ◽  
Yumei Liu ◽  
Xunming Ji ◽  
...  
Keyword(s):  
Systematic Review ◽  
Risk Factor ◽  
Mobile Health ◽  
Stroke Risk ◽  
Meta Analysis ◽  
Risk Factor Control ◽  
Stroke Risk Factor

scholarly journals Impact of a single non-sex-related stroke risk factor on atrial fibrillation and oral anticoagulant outcomes: a systematic review and meta-analysis

Open Heart ◽  
2020 ◽  
Vol 7 (2) ◽  
pp. e001465
Author(s):  
Maxim Grymonprez ◽  
Stephane Steurbaut ◽  
An De Sutter ◽  
Lies Lahousse
Keyword(s):  
Diabetes Mellitus ◽  
Atrial Fibrillation ◽  
Systematic Review ◽  
Risk Factor ◽  
Vitamin K ◽  
Stroke Risk ◽  
Meta Analysis ◽  
Oral Anticoagulants ◽  
Stroke Risk Factor ◽  
Thromboembolic Risk

AimsOral anticoagulants (OACs) are crucial for treating atrial fibrillation (AF) patients at high thromboembolic risk. However, in AF patients at intermediate thromboembolic risk with a single non-sex-related stroke risk factor (CHA2DS2-VASc score 1 in men, 2 in women), guidelines advise to consider starting anticoagulation, which may result in OAC non-initiation due to underestimation of the thromboembolic risk of a single stroke risk factor and overestimation of the OAC-related bleeding risk. A critical appraisal of the role of OACs and the benefit–risk profile of non-vitamin K antagonist oral anticoagulants (NOACs) compared with vitamin K antagonists (VKAs) in this patient subgroup are needed.Methods and resultsThis systematic review provides an overview of literature on the effectiveness and safety of OACs in AF patients with a single non-sex-related stroke risk factor after searching Medline and Embase. Differences between individual stroke risk factors regarding the ischaemic stroke risk in non-anticoagulated AF patients are identified in a meta-analysis, demonstrating the highest increased risk in patients aged 65–74 years old or with diabetes mellitus, followed by heart failure, hypertension and vascular disease. Furthermore, meta-analysis results favour NOACs over VKAs, given their equal effectiveness and superior safety in AF patients at intermediate thromboembolic risk (HR 0.93, 95% CI 0.65 to 1.34 for stroke or systemic embolism; HR 0.60, 95% CI 0.45 to 0.80 for major bleeding; HR 0.48, 95% CI 0.14 to 1.59 for intracranial bleeding; HR 0.58, 95% CI 0.47 to 0.71 for mortality).ConclusionOur systematic review with meta-analysis favours the use of anticoagulation in AF patients with a single non-sex-related stroke risk factor, especially when age ≥65 years or diabetes mellitus is present, with a preference for NOACs over VKAs.

Abstract TMP87: The Efficacy of a Chronic Care Based Intervention on Secondary Stroke Prevention Among Vulnerable Stroke Survivors: A Randomized, Controlled Trial

Stroke ◽  
2016 ◽  
Vol 47 (suppl_1) ◽  
Author(s):  
Eric M Cheng ◽  
William E Cunningham ◽  
Amytis Towfighi ◽  
Nerses Sanossian ◽  
Robert J Bryg ◽  
...  
Keyword(s):  
Risk Factor ◽  
Usual Care ◽  
Care Management ◽  
Chronic Care ◽  
Stroke Risk ◽  
Public Hospitals ◽  
Risk Factor Control ◽  
Stroke Risk Factor ◽  
Management Intervention ◽  
The Impact

Background: Effective interventions to improve stroke preventative care in vulnerable populations have not been reported. Methods: We tested the impact of a chronic care model-based intervention program among 407 subjects with a recent stroke or transient ischemic attack at four Los Angeles County public hospitals. All subjects had a baseline systolic blood pressure (SBP) of at least 120 mm Hg and were randomized after baseline assessment in a 1:1 ratio to usual care or intervention, stratified by hospital and by English/Spanish language. The care management intervention was led by bilingual nurse practitioners or physician assistants, and it consisted of group clinics, self-management support, report cards, decision support, and coordination of ongoing care. Intention-to-treat analyses were conducted using repeated-measures mixed-effects models. The primary outcome was change in SBP. Secondary outcomes were other measures of SBP, low-density lipoprotein (LDL), ACC/AHA 10-year cardiovascular risk, adherence to antihypertensive and to antithrombotic medications, and physical activity. Results: Mean age was 57 years, 60% were male, 18% were African-American race, and 69% were Hispanic ethnicity. 48% had not graduated from high school. Baseline SBP was 150 mm Hg in the usual care arm and 149 mm Hg in the intervention arm. 12 month data were obtained in 333 participants (82%). There were substantial declines in SBP in both the usual care and intervention arms (Table). However, there were no significant differences between the two arms in either improvement of SBP from baseline or other measures of stroke risk factor control. Subgroup analyses did not reveal a differential impact of the intervention by race/ethnicity. Conclusion: Our care management intervention did not improve stroke risk factor control beyond what was attained in usual care. Further analyses are ongoing, and those findings will be used to guide modification of the intervention for future testing.

Abstract TMP98: Could Mobile Health be an Effective Strategy for Enhancing Stroke Prevention?

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Shimeng Liu ◽  
Wuwei Feng ◽  
Pratik Y Chhatbar ◽  
Bruce I Ovbiagele
Keyword(s):  
Risk Factors ◽  
Smoking Cessation ◽  
Risk Factor ◽  
Glycemic Control ◽  
Mobile Health ◽  
Meta Analysis ◽  
Vascular Risk Factor ◽  
Smoking Abstinence ◽  
Vascular Risk ◽  
Risk Factor Control

Background: The overwhelming majority of strokes can be prevented via optimal vascular risk factor control. However, there remains an evidence practice gap with regard to treatment of vascular risk factors. With the rapid growth worldwide in cell-phone use, Internet connectivity, and digital health technology, mobile health (mHealth) technology may offer a promising approach to bridge these treatment gaps and reduce the global burden of stroke. Objective: To evaluate the effectiveness of mHealth in vascular risk factor control through a systemic review and meta-analysis. Methods: We searched PubMed from January 1, 2000 to May 17, 2016 using keywords: mobile health, mhealth, short message, cellular phone, mobile phone, stroke prevention and control, diabetes mellitus, hypertension, hyperlipidemia and smoking cessation. We performed a meta-analysis of all eligible randomized control clinical trials that assessed the long-term (at 6 months) effect of mHealth. Results: Of 79 articles identified, 13 of them met eligibility criteria (6 for glycemic control and 7 for smoking cessation) and were included for the final meta-analysis. There were no eligible studies for dyslipidemia or hypertension. mHealth resulted in greater HbA1c reduction at 6 months (6 studies; 663 subjects; SMD: -0.44; 95% CI: [-0.82, -0.06], P =0.02; Mean difference of decrease in HbA1c: -0.39%; 95% CI: [-0.74,-0.04], P =0.03). mHealth also led to relatively higher smoking abstinence rates at 6 months (7 studies; 9,514 subjects; OR: 1.54; 95% CI: [1.24, 1.90], P <0.0001). Conclusion: Use of mHealth improves glycemic control and smoking abstinence rates, two factors that may lead to better stroke outcomes. Future mHealth studies should focus on modifying premier vascular risk factors like hypertension, specifically in people with or at risk of stroke.

scholarly journals EXPRESS: Stroke risk following traumatic brain injury: systematic review and meta-analysis

2021 ◽  
pp. 174749302110042
Author(s):  
Grace Mary Turner ◽  
Christel McMullan ◽  
Olalekan Lee Aiyegbusi ◽  
Danai Bem ◽  
Tom Marshall ◽  
...  
Keyword(s):  
Systematic Review ◽  
Stroke Risk ◽  
Meta Analysis ◽  
Vitamin K Antagonists ◽  
Cochrane Library ◽  
Control Group ◽  
Large Sample Size ◽  
Hazard Ratios ◽  
Increased Risk ◽  
The Cochrane Library

Aims To investigate the association between TBI and stroke risk. Summary of review We undertook a systematic review of MEDLINE, EMBASE, CINAHL, and The Cochrane Library from inception to 4th December 2020. We used random-effects meta-analysis to pool hazard ratios (HR) for studies which reported stroke risk post-TBI compared to controls. Searches identified 10,501 records; 58 full texts were assessed for eligibility and 18 met the inclusion criteria. The review included a large sample size of 2,606,379 participants from four countries. Six studies included a non-TBI control group, all found TBI patients had significantly increased risk of stroke compared to controls (pooled HR 1.86; 95% CI 1.46-2.37). Findings suggest stroke risk may be highest in the first four months post-TBI, but remains significant up to five years post-TBI. TBI appears to be associated with increased stroke risk regardless of severity or subtype of TBI. There was some evidence to suggest an association between reduced stroke risk post-TBI and Vitamin K antagonists and statins, but increased stroke risk with certain classes of antidepressants. Conclusion TBI is an independent risk factor for stroke, regardless of TBI severity or type. Post-TBI review and management of risk factors for stroke may be warranted.

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