Stroke is the second leading cause of death and one of the main contributors to
disability. Patients who survive the acute phase of ischemic stroke and those with a
transient ischemic attack (TIA) are at high risk of subsequent stroke. Importantly,
recurrent strokes are associated with a higher social and economic impact, higher case
fatality, and worse clinical outcome than first-ever strokes. The burden of post-stroke
complications, residual deficits, and inadequate medical and psychosocial care all
contribute to long-term disability and reduced quality of life in these patients.
Furthermore, effects on quality of life and long-term functional independence are
particularly under-investigated.
The Department of Neurology of the Medical University Innsbruck undertook the STROKE-CARD
trial (NCT02156778) between 2014 and 2018 with follow-up until 2019 to evaluate the
efficacy of the Post-Stroke disease management program STROKE-CARD care. The aim is to
evaluate this program in a large multicenter cohort and to establish a biobank of stroke
and TIA-patients for future research and development projects.
In brief, the pragmatic and easily implementable STROKE-CARD care program reduced
cardiovascular risk and improved health-related quality of life and functional outcome in
patients with acute ischemic stroke or TIA in a timeframe of 12 months after the index
event. To investigate the effects of STROKE-CARD care on a large basis and over a longer
period, an evaluation of approximately 5,000 patients is warranted.
Whereas disease management programs typically rely on expert opinion, the STROKE-CARD
initiative moved from a purely empirical approach to a highly structured, individualized,
and evidence-based procedure with professional outcome analysis. The STROKE-CARD concept
will be implemented in clinical practice and can serve as a model for other disease
management initiatives.
Acute and short-term management of stroke and TIA has improved tremendously over the past
years with substantial advances in acute therapy, implementation of comprehensive
pathways for stroke and TIA, and approval of novel highly effective preventive
treatments. As a main unmet challenge in stroke medicine, strategies of long-term care
have to be developed and rigorously tested in order to maintain improved short-term
patient outcome in the long run.
STROKE-CARD care reduced the one-year cumulative absolute risk of CVD and ameliorated the
patients' health-related quality of life at 12 months (EQ-5D-3L overall utility score,
P<0.001). These findings were consistent in subgroups according to age, sex, and index
event and were robust in the per-protocol analysis. Among pre-specified secondary
outcomes assessed at 12 months, the investigators observed improvements in all individual
dimensions of the EQ-5D-3L and in one-year functional outcome, that each met the
multiplicity-adjusted threshold for statistical significance. Only a few previous trials
of disease management programs in stroke and TIA patients have focused on recurrent CVD
or quality of life as primary or secondary endpoints and none has considered long-term
functional outcome after one year. The previous trial was limited to a 12-month follow-up
in selected individuals and the sustainability of benefits of STROKE-CARD care in a large
nationwide cohort over a longer follow-up period remains to be determined.
This study aims to detect post-stroke complications, to estimate the patient's demand for
nursing services, and support guideline-compliant secondary prevention with full
achievement of target levels, lifestyle modifications, and in-person outcome assessment
at 3 and 12 months after the index-event, assessment of functional status (impairment),
activity (disability), and participation (handicap and health-related quality of life).
Additionally, yearly follow-up telephone interviews for cardiovascular outcome and health
parameters will be conducted. In case of clinically indicated in-person follow-ups, the
interviews will be done in person during the clinical visits. After the implementation of
STROKE-CARD care, the investigators aim to document the quality of post-stroke care and
compare outcome parameters to historical cohorts and the change over time. Furthermore,
the investigators aim to gain a large data resource for future research of biomarkers,
disease mechanisms, prognosis and imaging mechanisms for R&D.
The main objective is to evaluate the Post-Stroke Disease Management program STROKE-CARD
in a large multicenter cohort of stroke and TIA-patients and to establish a large
clinical well-defined cohort. Furthermore, the investigators aim to gain a large data
resource for future research of biomarkers, disease mechanisms, prognosis and imaging
mechanisms for R&D.
To document and monitor the quality of the Post-Stroke Disease Management program in
different centers and compare outcomes to the historical cohort, as well as other
published data. Furthermore, the investigators aim to constantly improve post-stroke
care. This registry can facilitate to monitor and document the effect on the primary and
secondary outcomes.
There will be no formal safety endpoints in this study. No experimental procedures will
be applied to patients and most of the procedures done are within the clinical routine.
Potential side effects of optimal secondary stroke prevention are recorded.
