title: ICARUSS, the Integrated Care for the Reduction of Secondary Stroke trial: rationale and design of a randomized controlled trial of a multimodal intervention to prevent recurrent stroke in patients with a recent cerebrovascular event, ACTRN = 12611000264987.
abstract: BACKGROUND
  The majority of strokes, both ischaemic and haemorrhagic, are attributable to a relatively small number of risk factors which are readily manageable in primary care setting. Implementation of best-practice recommendations for risk factor management is calculated to reduce stroke recurrence by around 80%. However, risk factor management in stroke survivors has generally been poor at primary care level. A model of care that supports long-term effective risk factor management is needed.
  
  
  OBJECTIVE
  To determine whether the model of Integrated Care for the Reduction of Recurrent Stroke (ICARUSS) will, through promotion of implementation of best-practice recommendations for risk factor management reduce the combined incidence of stroke, myocardial infarction and vascular death in patients with recent stroke or transient ischaemic attack (TIA) of the brain or eye.
  
  
  METHODS
  A prospective, Australian, multicentre, randomized controlled trial.
  
  
  METHODS
  Academic stroke units in Melbourne, Perth and the John Hunter Hospital, New South Wales.
  
  
  METHODS
  1000 stroke survivors recruited as from March 2007 with a recent (<3 months) stroke (ischaemic or haemorrhagic) or a TIA (brain or eye).
  
  
  METHODS
  Randomization and data collection are performed by means of a central computer generated telephone system (IVRS).
  
  
  METHODS
  Exposure to the ICARUSS model of integrated care or usual care.
  
  
  METHODS
  The composite of stroke, MI or death from any vascular cause, whichever occurs first.
  
  
  RESULTS
  Risk factor management in the community, depression, quality of life, disability and dementia.
  With 1000 patients followed up for a median of one-year, with a recurrence rate of 7-10% per year in patients exposed to usual care, the study will have at least 80% power to detect a significant reduction in primary end-points
  
  
  CONCLUSIONS
  The ICARUSS study aims to recruit and follow up patients between 2007 and 2013 and demonstrate the effectiveness of exposure to the ICARUSS model in stroke survivors to reduce recurrent stroke or vascular events and promote the implementation of best practice risk factor management at primary care level.
authors.affiliation: Departments of Medicine and Neurology, University of Melbourne, Melbourne, Victoria, Australia.|Department of Neurology, Royal Melbourne Hospital, Parkville, Victoria, Australia.|Department of Neurology, St Vincents Hospital, Melbourne, Victoria, Australia.
authors.forename: J
authors.initials: J
authors.lastname: Joubert
authors.affiliation: Department of Neurology, Royal Melbourne Hospital, Parkville, Victoria, Australia.|Florey Institute, Melbourne, Victoria, Australia.
authors.forename: S M
authors.initials: SM
authors.lastname: Davis
authors.affiliation: Department of Neurology, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia.
authors.forename: G J
authors.initials: GJ
authors.lastname: Hankey
authors.affiliation: Hunter Medical Research Institute, Newcastle, New South Wales, Australia.
authors.forename: C
authors.initials: C
authors.lastname: Levi
authors.affiliation: Department of Medicine, Monash University, Melbourne, Victoria, Australia.
authors.forename: J
authors.initials: J
authors.lastname: Olver
authors.affiliation: Department of Neurology, St Vincents Hospital, Melbourne, Victoria, Australia.
authors.forename: G
authors.initials: G
authors.lastname: Gonzales
authors.affiliation: Florey Institute, Melbourne, Victoria, Australia.
authors.forename: G A
authors.initials: GA
authors.lastname: Donnan
mesh_terms: D001315:Australia; D019468:Disease Management; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D011788:Quality of Life; D012008:Recurrence; D012189:Retrospective Studies; D012307:Risk Factors; D018401:Sample Size; D055502:Secondary Prevention / Q000379:methods*; D020521:Stroke / Q000628:therapy*; D016896:Treatment Outcome
keywords: integrated care; prevention; risk factors; stroke