title: Nurse-Led, Telephone-Based, Secondary Preventive Follow-Up after Stroke or Transient Ischemic Attack Improves Blood Pressure and LDL Cholesterol: Results from the First 12 Months of the Randomized, Controlled NAILED Stroke Risk Factor Trial.
abstract: BACKGROUND
  Enhanced secondary preventive follow-up after stroke or transient ischemic attack (TIA) is necessary for improved adherence to recommendations regarding blood pressure (BP) and low-density lipoprotein cholesterol (LDL-C) levels. We investigated whether nurse-led, telephone-based follow-up was more efficient than usual care at improving BP and LDL-C levels at 12 months after hospital discharge.
  
  
  METHODS
  We randomized 537 patients to either nurse-led, telephone-based follow-up (intervention) or usual care (control). BP and LDL-C measurements were performed at 1 month (baseline) and 12 months post-discharge. Intervention group patients who did not meet target values at baseline received additional follow-up, including titration of medication and lifestyle counselling, to reach treatment goals (BP < 140/90 mmHg, LDL-C < 2.5 mmol/L).
  
  
  RESULTS
  At 12 months, mean systolic BP, diastolic BP and LDL-C was 3.3 (95% CI 0.3 to 6.3) mmHg, 2.3 mmHg (95% CI 0.5 to 4.2) and 0.3 mmol/L (95% CI 0.1 to 0.4) lower in the intervention group compared to controls. Among participants with values above the treatment goal at baseline, the difference in systolic BP and LDL-C was more pronounced (8.0 mmHg, 95% CI 4.0 to 12.1, and 0.6 mmol/L, 95% CI 0.4 to 0.9). A larger proportion of the intervention group reached the treatment goal for systolic BP (68.5 vs. 56.8%, p = 0.008) and LDL-C (69.7% vs. 50.4%, p < 0.001).
  
  
  CONCLUSIONS
  Nurse-led, telephone-based secondary preventive follow-up, including medication adjustment, was significantly more efficient than usual care at improving BP and LDL-C levels by 12 months post-discharge.
  
  
  BACKGROUND
  ISRCTN Registry ISRCTN23868518.
authors.affiliation: Department of Public Health and Clinical Medicine, Östersund, Umeå University, Umeå, Sweden.
authors.forename: Anna-Lotta
authors.initials: AL
authors.lastname: Irewall
authors.affiliation: Department of Public Health and Clinical Medicine, Östersund, Umeå University, Umeå, Sweden.
authors.forename: Joachim
authors.initials: J
authors.lastname: Ögren
authors.affiliation: Department of Public Health and Clinical Medicine, Östersund, Umeå University, Umeå, Sweden.
authors.forename: Lisa
authors.initials: L
authors.lastname: Bergström
authors.affiliation: Department of Pharmacology and Clinical Neuroscience, Östersund, Umeå University, Umeå, Sweden.
authors.forename: Katarina
authors.initials: K
authors.lastname: Laurell
authors.affiliation: Unit of Research, Development and Education, Region Jämtland Härjedalen, Östersund Hospital, Östersund, Sweden.
authors.forename: Lars
authors.initials: L
authors.lastname: Söderström
authors.affiliation: Department of Public Health and Clinical Medicine, Östersund, Umeå University, Umeå, Sweden.
authors.forename: Thomas
authors.initials: T
authors.lastname: Mooe
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001794:Blood Pressure; D002545:Brain Ischemia / Q000097:blood / Q000503:physiopathology / Q000517:prevention & control; D008078:Cholesterol, LDL / Q000097:blood*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D009726:Nurses; D012307:Risk Factors; D020521:Stroke / Q000097:blood / Q000503:physiopathology / Q000517:prevention & control
chemical_list: D008078:Cholesterol, LDL