Does Post-Stroke Care Need to Improve Clinical Endpoints?

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Does Post-Stroke Care Need to Improve Clinical Endpoints?

MUNICH — A multidisciplinary post-stroke care program failed to show a reduction in hard clinical endpoints over standard care after 1 year of follow-up, a new study shows, although it did achieve improvements in cardiovascular risk-related measures.

Experts argued that the trial, presented at the European Stroke Organisation Conference (ESOC) 2023 on May 24, would always have struggled to show a benefit when the background standard of care was so high and the study period was so short.

The program, dubbed structured ambulatory post-stroke care program (SANO), was a complex intervention that brought together a host of healthcare professionals and facilities to cooperate with patients to achieve a whole series of cardiovascular risk factor targets.

They randomly assigned 30 clusters or regions in southwestern Germany, each representing one stroke unit, to the intervention or standard care. A total of almost 2800 patients participated. The primary endpoint was a reduction in the rate of a composite of major cardiovascular adverse events at 1-year follow-up.

This was not met, but patients in the intervention arm were significantly more likely than those receiving standard care to achieve their low-density lipoprotein (LDL) cholesterol target, to be receiving statin therapy, and to have quit smoking.

The program "has shown positive effects in optimizing control of some cardiovascular risk factors in stroke patients," said Christopher J. Schwarzbach, MD, Neurology Department, Klinikum der Stadt Ludwigshafen am Rhein, Ludwigshafen am Rhein, Germany.

However, "These effects did not translate into a reduction of the rate of major cardiovascular events at 12 months after ischemic stroke," he said, potentially because the "follow-up period might be too short to demonstrate a positive effect."

Schwarzbach suggested that the long-term effects of the intervention may need to be considered, along with other potentially favorable effects of the structured intervention of stroke-related sequelae and quality of life.

Session co-chair Robin Lemmens, MD, PhD, a neurologist in the Department of Neurosciences, UZ Leuven, Leuven, Belgium, commented that an important point to consider regarding the results is the "very high" standard of care in the control arm.

He told Medscape Medical News that it is therefore "probably going to be difficult to prove a benefit."

Lemmens said, however, that the researchers should be complimented, as the exploratory analyses showed some "exciting results" in terms of smoking cessation, statin use, and LDL cholesterol lowering.

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