Stroke in Sri Lanka: How Can We Minimise the Burden?

The burden of stroke in Sri Lanka is high and steadily increasing. Accurate estimation of the burden is hampered by a paucity of epidemiological data. More neurologists, stroke units, facilities for modern treatments and multi-disciplinary rehabilitation services are urgently needed. Essential drugs for risk factor control and secondary prevention are available in many hospitals. Aggressive preventive strategies and promoting stroke awareness are the best ways to minimise the stroke burden in Sri Lanka.

Download Full-text

Abstract TMP99: Farmalarm: App for Mobile Devices Improves Risk Factor Control After Stroke

Stroke ◽

10.1161/str.48.suppl_1.tmp99 ◽

2017 ◽

Vol 48 (suppl_1) ◽

Author(s):

Marc Ribo ◽

Estefania montiel ◽

Estela Sanjuan ◽

Mireia Sanchis ◽

Marta Rubiera ◽

...

Keyword(s):

Risk Factors ◽

Risk Factor ◽

Medical Staff ◽

Healthy Lifestyle ◽

Medication Compliance ◽

Treatment Compliance ◽

Lifestyle Changes ◽

Stroke Patients ◽

Risk Factor Control ◽

Stroke Awareness

Risk factor control and treatment compliance in the following months after stroke are often poor. We aim to validate a digital platform for smartphones designed to raise awareness in patients about the need to perform healthy lifestyle changes, improve communication with medical staff and increase treatment compliance Methods: Farmalarm is an app for smartphones designed to increase stroke awareness by: medication visual alerts and compliance control, chat communication with medical staff, sharing didactic video files, exercise monitoring... Stroke patients discharged home were screened for participation and divided in two groups: to follow the FARMALARM program during 3-4 weeks or standard of care follow-up. We determined risk factor control goals at 90 days in all patients Results: During 16 months, from the 457 patients discharged home, 126 (27.6%) were included in the study: Farmalarm n=74; age 57±12, Control n=52, age 59±10. There were no significant differences in baseline characteristics between groups. Patients in Farmalarm group followed the program for 23±6 days after discharge. In Farmalarm group, mean number alarms due to medication intake failure dropped from 68.5% in the first week to 44.6% in the third week (p=0.03). At 90 days, achievement of risk factor control was higher in the FARMALARM group (table). The rate of patients with 4/4 risk factors under control was higher in the FARMALARM group (45.3% Vs 22.5%; p=0.02) (graph) and less patients dropped all medications at 3 months in the Farmalarm group (1.5% Vs 8.16%:p=0.05). A regression model adjusted for age and gender showed that the only variable independently associated with all risk factors under control at 90 days was the use of Farmalarm (OR: 4.7; 95% CI:1.1-6.9;p=0.03). Conclusion: In stroke patients discharged home the use of mobile applications to monitor medication compliance and increase stroke awareness is feasible and seems to improve the control of vascular risk factors.

Download Full-text

Therapeutic Interventions and Success in Risk Factor Control for Secondary Prevention of Stroke

Journal of Stroke and Cerebrovascular Diseases ◽

10.1016/j.jstrokecerebrovasdis.2009.01.014 ◽

2009 ◽

Vol 18 (6) ◽

pp. 460-465 ◽

Cited By ~ 27

Author(s):

Jose Alvarez-Sabin ◽

Manuel Quintana ◽

Miguel Angel Hernandez-Presa ◽

Carlos Alvarez ◽

Jose Chaves ◽

...

Keyword(s):

Risk Factor ◽

Secondary Prevention ◽

Therapeutic Interventions ◽

Risk Factor Control

Download Full-text

Risk factor control in secondary prevention of cardiovascular disease: results from the multi-ethnic HELIUS study

Netherlands Heart Journal ◽

10.1007/s12471-017-0956-5 ◽

2017 ◽

Vol 25 (4) ◽

pp. 250-257 ◽

Cited By ~ 4

Author(s):

M. Minneboo ◽

S. Lachman ◽

M. B. Snijder ◽

J. T. Vehmeijer ◽

H. T. Jørstad ◽

...

Keyword(s):

Cardiovascular Disease ◽

Risk Factor ◽

Secondary Prevention ◽

Risk Factor Control ◽

Helius Study ◽

Prevention Of Cardiovascular Disease

Download Full-text

A retrospective cohort study examining secondary prevention post stroke in primary care in an Asian setting

BMC Family Practice ◽

10.1186/s12875-021-01412-0 ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Vivek Bansal ◽

Eng Sing Lee ◽

Helen Smith

Keyword(s):

Risk Factors ◽

Atrial Fibrillation ◽

Primary Care ◽

Risk Factor ◽

Cohort Study ◽

High Risk ◽

Secondary Prevention ◽

Retrospective Cohort ◽

Low Risk ◽

Risk Factor Control

Abstract Background Stroke is one of the top contributors to burden of disability-adjusted life-years worldwide. Family physicians have key role in optimising secondary prevention following stroke by managing clinical risk factors and promoting overall control in accordance with clinical practice guidelines. Methods Our objectives were: (i) to examine level of overall risk factor control together with control of singular risk factors one-year after an index-stroke event in individuals attending primary care facility and (ii) to describe factors associated with satisfactory risk factors control in individuals following stroke. Study Design: Retrospective cohort study. We conducted a study looking retrospectively at records from our electronic chronic disease database. Our study included individuals following stroke who visited primary care setting in Singapore between January 2012 to December 2016. Results There were 24,240 individuals in our study. Overall control was better in individuals without diabetes following stroke (49.2%) as compared to those with diabetes (28.1%). Among individuals without diabetes following stroke, factors significantly associated with overall control were sex (male) [OR (reference: female): 1.23, 95% CI: 1.10, 1.39], ethnicity (Malay) [OR (reference: Chinese): 0.72, 95% CI: 0.58, 0.90], BMI (high risk) [OR (reference: low risk): 0.72, 95% CI: 0.62, 0.84) and atrial fibrillation [OR: 1.47, 95% CI: 1.21, 1.78]. Among individuals with diabetes following stroke, factors significantly associated with overall control were sex (male) [OR (reference: female): 1.28, 95% CI: 1.12, 1.46], ethnicity (Malay) [OR (reference: Chinese): 0.81, 95% CI: 0.65, 0.99], ethnicity (Indian) [OR (reference: Chinese): 0.70, 95% CI: 0.55, 0.88], BMI (high risk) [OR (reference: low risk): 0.71, 95% CI: 0.59, 0.84), BMI (moderate risk) [OR (reference: low risk): 0.84, 95% CI: 0.72, 0.98), atrial fibrillation [OR: 1.24; 95% CI: 1.02, 1.51], chronic kidney disease [OR: 0.63, 95% CI: 0.54, 0.72] and smoking status [OR: 0.68, 95% CI: 0.54, 0.88]. Conclusion We reported sub-optimal level of overall control. Among individuals following stroke, those with diabetes had higher proportion of sub-optimal control as compared to those without diabetes. Irrespective of diabetic status, being female, having high BMI, and of Malay ethnicity as compared to Chinese ethnicity were associated with poorer overall risk factor control.

Download Full-text

Interventions for improving modifiable risk factor control in the secondary prevention of stroke

Cochrane Database of Systematic Reviews ◽

10.1002/14651858.cd009103.pub3 ◽

2018 ◽

Cited By ~ 11

Author(s):

Bernadeta Bridgwood ◽

Kate E Lager ◽

Amit K Mistri ◽

Kamlesh Khunti ◽

Andrew D Wilson ◽

...

Keyword(s):

Risk Factor ◽

Secondary Prevention ◽

Modifiable Risk Factor ◽

Risk Factor Control

Download Full-text

Interhospital and interindividual variability in secondary prevention: a comparison of outpatients with a history of chronic coronary syndrome versus outpatients with a history of acute coronary syndrome (the iASPIRE Study)

Open Heart ◽

10.1136/openhrt-2021-001659 ◽

2021 ◽

Vol 8 (1) ◽

pp. e001659

Author(s):

James MG Curneen ◽

Conor Judge ◽

Bryan Traynor ◽

Anthony Buckley ◽

Lavanya Saiva ◽

...

Keyword(s):

Acute Coronary Syndrome ◽

Risk Factor ◽

Secondary Prevention ◽

Low Density Lipoprotein ◽

Density Lipoprotein ◽

Risk Factor Control ◽

Coronary Syndrome ◽

Prevention Programmes ◽

History Of ◽

Study Sites

BackgroundStudying variability in the care provided to secondary prevention coronary heart disease (CHD) outpatients can identify interventions to improve their outcomes.MethodsWe studied outpatients who had an index CHD event in the preceding 6–24 months. Eligible CHD events included acute coronary syndrome (ACS) and coronary revascularisation for stable chronic coronary syndrome (CCS). Site training was provided by a core team and data were collected using standardised methods.ResultsBetween 2017 and 2019, we enrolled 721 outpatients at nine Irish study sites; 81% were men and mean age was 63.9 (SD ±8.9) years. The study examination occurred a median of 1.16 years after the index CHD event, which was ACS in 399 participants (55%) and stable-CCS in 322. On examination, 42.5% had blood pressure (BP) >140/90 mm Hg, 63.7% had low-density lipoprotein cholesterol (LDL-C) >1.8 mmol/L and 44.1% of known diabetics had an HbA1c >7%. There was marked variability in risk factor control, both by study site and, in particular, by index presentation type. For example, 82% of outpatients with prior-ACS had attended cardiac rehabilitation versus 59% outpatients with prior-CCS (p<0.001) and there were also large differences in control of traditional risk factors like LDL-C (p=0.002) and systolic BP (p<0.001) among outpatients with prior-ACS versus prior-CCS as the index presentation.ConclusionsDespite international secondary prevention guidelines broadly recommending the same risk factor targets for all adults with CHD, we found marked differences in outpatient risk factor control and management on the basis of hospital location and index CHD presentation type (acute vs chronic). These findings highlight the need to reduce hospital-level and patient-level variability in preventive care to improve outcomes; a lesson that should inform CHD prevention programmes in Ireland and around the world.

Download Full-text