title: The stroke east Saxony pilot project for organized post-stroke care: a case-control study.
abstract: Low adherence to secondary prevention guidelines in stroke survivors may increase the risk for recurrent stroke and adversely impact quality of life. We aimed to determine the feasibility of a self-developed standardized post-stroke pathway and its impact on secondary stroke prevention and long-term outcome in patients with acute stroke.
  
  
  
  Consecutive patients with acute stroke were prospectively included in a standardized post-stroke pathway accomplished through a single certified CM (case manager), which comprised educational discussions and quarterly checkups for vascular risk factors and adherence to antithrombotic/anticoagulant medication in addition to usual care. At 12 months, we compared achieved target goals for secondary prevention, functional outcome, stroke recurrence, and vascular death with age- and gender-matched controls that received only usual care after stroke.
  
  
  
  We included 45 cases and 45 controls. The following target goals were more frequently achieved in CM-patients than in controls: blood pressure (100% vs. 46.2%, P < 0.001), cholesterol (100% vs. 74.4%, P < 0.001), and body mass index (67.4% vs. 46.2%, P = 0.052). The CM-intervention emerged as an independent predictor of favorable functional outcome (mRS ≤ 2) at 12 months after adjusting for stroke severity and systemic thrombolysis (OR: 4.27; 95%CI:1.2-15.21; P = 0.025). Quality of life was rated significantly higher in CM-patients than in controls (P = 0.049). As opposed to controls, none of the cases experienced a recurrent stroke (0% vs. 13.3%; P = 0.026) or suffered from vascular death (0% vs. 6.7%; P = 0.242).
  
  
  
  Our pilot data suggest that organized post-stroke care enhances achievement of secondary prevention goals. Its possible effect on stroke recurrence, long-term disability, and quality of life is currently investigated in a prospective cohort study.
authors.affiliation: Department of Neurology University Hospital Carl Gustav Carus Technische Universität Dresden Dresden Germany.
authors.forename: Ulf
authors.initials: U
authors.lastname: Bodechtel
authors.affiliation: Department of Neurology University Hospital Carl Gustav Carus Technische Universität Dresden Dresden Germany.
authors.forename: Kristian
authors.initials: K
authors.lastname: Barlinn
authors.affiliation: Department of Neurology University Hospital Carl Gustav Carus Technische Universität Dresden Dresden Germany.
authors.forename: Uwe
authors.initials: U
authors.lastname: Helbig
authors.affiliation: Center for Evidence-Based Healthcare University Hospital Carl Gustav Carus Technische Universität Dresden Dresden Germany.
authors.forename: Katrin
authors.initials: K
authors.lastname: Arnold
authors.affiliation: Department of Neurology University Hospital Carl Gustav Carus Technische Universität Dresden Dresden Germany.
authors.forename: Timo
authors.initials: T
authors.lastname: Siepmann
authors.affiliation: Department of Neurology University Hospital Carl Gustav Carus Technische Universität Dresden Dresden Germany.
authors.forename: Lars-Peder
authors.initials: LP
authors.lastname: Pallesen
authors.affiliation: Department of Neurology University Hospital Carl Gustav Carus Technische Universität Dresden Dresden Germany.
authors.forename: Volker
authors.initials: V
authors.lastname: Puetz
authors.affiliation: Department of Neurology University Hospital Carl Gustav Carus Technische Universität Dresden Dresden Germany.
authors.forename: Heinz
authors.initials: H
authors.lastname: Reichmann
authors.affiliation: Center for Evidence-Based Healthcare University Hospital Carl Gustav Carus Technische Universität Dresden Dresden Germany.
authors.forename: Jochen
authors.initials: J
authors.lastname: Schmitt
authors.affiliation: Department of Neurology University Hospital Carl Gustav Carus Technische Universität Dresden Dresden Germany; Center for Evidence-Based Healthcare University Hospital Carl Gustav Carus Technische Universität Dresden Dresden Germany.
authors.forename: Jessica
authors.initials: J
authors.lastname: Kepplinger
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D019090:Case Management / Q000458:organization & administration*; D016022:Case-Control Studies; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D005858:Germany; D006801:Humans; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D017060:Patient Satisfaction; D010865:Pilot Projects; D011788:Quality of Life; D055502:Secondary Prevention / Q000458:organization & administration*; D020521:Stroke / Q000517:prevention & control*; D000071939:Stroke Rehabilitation
keywords: Post‐stroke program; secondary stroke prevention