Nurse-led, telephone-based secondary preventive follow-up benefits stroke/TIA patients with low education: a randomized controlled trial sub-study

BackgroundThe objective of this study was to analyze the impact of two forms of secondarypreventive follow-up on the association between education level and levels of blood pressure (BP) and low-density lipoprotein cholesterol (LDL-C) after stroke/transient ischemic attack (TIA).MethodsWe included a population-based cohort of 771 stroke and TIA patients randomly assigned (1:1) to secondary preventive follow-up within primary health care (control) or nurse-led, telephone-based follow-up (intervention) between January 1, 2010, and December 31, 2013, as part of the NAILED (nurse-based age-independent intervention to limit evolution of disease) stroke risk factor trial. We compared BP and LDL-C levels 12months after hospital discharge in relation to education level (low, 10years; high, >10years) separately for the intervention and control groups.ResultsAmong controls, systolic BP (SBP) decreased only among the highly educated (-2.5mm Hg, 95% confidence interval (CI) -0.2 to -4.8), whereas LDL-C increased in the low-education group (0.2mmol/L, 95% CI 0.1 to 0.3). At 12months, controls with low education not more than 70years of age had higher SBP than controls of the same age with high education (5.8mm Hg, 95% CI 1.0 to 10.6). In contrast, SBP in the intervention group decreased similarly regardless of education level, LDL-C decreased among those with low education (-0.3mmol/L, 95% CI -0.2 to -0.4) and, in the subgroup not more than 70years old, low-educated participants had lower LDL-C at 12months than those with high education (0.3mmol/L, 95% CI 0.1 to 0.5).ConclusionsNurse-led, telephone-based secondary preventive follow-up led to comparable improvements in BP across education groups, while routine follow-up disfavored those with low education.Trial registrationISRCTN Registry ISRCTN23868518, June 19, 2012 - Retrospectively registered.