A stroke preparedness RCT in a multi-ethnic cohort: design and methods.
BACKGROUND
Tissue plasminogen activator (tPA), the only approved treatment for acute ischemic stroke (IS), is significantly underutilized likely due to poor lay information about stroke as an emergency. In order to improve outcomes in acute IS, it is critical to raise awareness and recognition of stroke symptoms particularly among minority populations. This manuscript describes the application of a stroke preparedness behavioral intervention and includes baseline information in a multi-ethnic population of stroke and transient ischemic attack (TIA) survivors.


METHODS
In the Stroke Warning Information and Faster Treatment Study (SWIFT), we prospectively identified, and randomized IS and TIA patients to determine efficacy of a culturally tailored interactive stroke preparedness strategy. Data collected at baseline included acute stroke parameters, stroke knowledge, severity, social resources and vascular risk assessment.


RESULTS
Of the 736 enrolled to date, 76% were IS and 24% TIA events. The cohort was 51% female: 45% Hispanic, 26% White and 25% Black. Over 75% reported hypertension, 36% diabetes, and 16% cardiac disease. Mean time from onset to emergency department (ED) arrival was 46h (median 13h) differing significantly between Whites (mean 52h, median 11h) and Blacks (mean 52h, median 17h) versus Hispanics (mean 39h, median 11h). Knowledge that a stroke occurs in the brain differed significantly by between Whites (85%), Blacks (64%), Hispanics (66%, p<0.000).


CONCLUSIONS
Disparities remain in both action and knowledge surrounding acute stroke. Use of written information has not proven an effective means of changing health behaviors. We propose an interactive culturally tailored intervention to address behavioral change in acute stroke.
Boden-Albala
Bernadette
B
Department of Neurology, College of Physicians and Surgeons, Columbia University, New York, NY, USA. bb87@columbia.edu
Stillman
Josh
J
Perez
Thania
T
Evensen
Laura
L
Moats
Harmon
H
Wright
Clinton
C
Moon-Howard
Joyce
J
Doyle
Margaret
M
Paik
Myunghee C
MC
D015331:Cohort Studies; D005006:Ethnicity; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D002546:Ischemic Attack, Transient / Q000188:drug therapy* / Q000208:ethnology; D008297:Male; D008875:Middle Aged; D010353:Patient Education as Topic; D011446:Prospective Studies; D016032:Randomized Controlled Trials as Topic; D012107:Research Design; D020521:Stroke / Q000188:drug therapy* / Q000208:ethnology; D013997:Time Factors; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use*
D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator