A new strategy using telehealth to monitor blood pressure at home for several months immediately after a stroke had a positive impact on patient engagement and blood pressure control among people who live in historically under-resourced communities, according to preliminary research presented at this year’s International Stroke Conference (ISC 2022; 9–11 February, New Orleans, USA).
“Hypertension is the most important modifiable risk factor for a second or recurrent stroke,” said lead study author Imama Naqvi (Columbia University Vagelos College of Physicians and Surgeons and New York-Presbyterian/Columbia University Irving Medical Center, New York City, USA). “We know that a small change to lower systolic blood pressure reduces recurrent stroke risk by more than 20%. Yet, blood pressure is poorly controlled among more than half of stroke survivors. We also know that Black adults have a higher prevalence of uncontrolled blood pressure. In addition, Black and Hispanic populations have a higher risk of stroke, and the highest increase in stroke prevalence is expected to be among Hispanic males.”
In this feasibility study, the researchers from Columbia University tested the potential impact of a new, multidisciplinary strategy called Telehealth After Stroke Care (TASC) for stroke survivors who received post-stroke care at New York-Presbyterian/Columbia University Irving Medical Center. The study took place in the Northern Manhattan area, with an underserved community. Participants included 50 stroke survivors (44% Hispanic adults, 32% Black adults and 20% white adults; average age=64 years).
About half (54%) of the participants had up to a high school education, and 30% had private health insurance. They were randomly divided into two groups: half of the study participants received usual care (the control group) and the other half of the study participants were supported with enhanced telehealth after their stroke (the intervention group). Both groups were enrolled before hospital discharge and followed for 90 days—the window of time when the risk of having another stroke is the highest.
Patients assigned to the control group had a video conference appointment with a primary care professional one-to-two weeks after hospital discharge, and video conference appointments with a stroke specialist at six and 12 weeks after discharge. Participants in the enhanced telehealth group received mobile tablet devices, blood pressure monitors and video visits with a multidisciplinary team including pharmacy support. The home blood pressure monitor remotely sent the participant’s readings to their electronic health record. Based on these remote readings, a nurse provided call support and could escalate to telepharmacists and physicians, if needed. The enhanced telehealth group also received a plain-language blood pressure infographic in English or Spanish, specifically tailored to their individual health information, to help educate them about healthy blood pressure levels, goals and ways to improve their blood pressure. Home blood pressure was measured at the end of the study.
Key findings from the study included:
- The TASC strategy had a significant improvement in patient follow-up: 84% of patients in the enhanced telehealth group completed the 12-week study, compared to 64% of patients in the usual care group.
- Some 91% of patients in the enhanced telehealth group completed the video visit with primary care professionals and specialists, compared to 75% of patients in the usual care group.
- Blood pressure control was better in the enhanced telehealth group, at 76% compared to 25% control in the control group.
- Among Black study participants, blood pressure control improved from 40% of participants at enrolment to 100% at the study’s conclusion in the enhanced telehealth group and improved only from 14% to 29% in the control group.
“COVID-19 has highlighted numerous health inequities that make post-stroke care more difficult and created a gap in health outcomes for people from diverse racial and ethnic groups,” added Naqvi. “We need to devise ways to bridge this divide. Mobile health tools such as wireless blood pressure devices that enable remote monitoring are here to stay, and we need to find ways to utilise telemedicine to improve care for all stroke survivors. As physicians, we want to provide patients with equitable access to care and find the right post-stroke care interventions that engage patients and improve health outcomes.”
The researchers for this feasibility study have urged caution regarding interpreting its results—noting that, while promising, the findings warrant further replication in a larger trial.