Platform Presentation The Joint Annual Meeting of the Stroke Society of Australasia (SSA) and Smartstrokes 2023

Evaluation of the health service delivered secondary prevention program: Supporting Lifestyle and Activity Modification after TIA (SLAM-TIA) (#40)

Heidi Janssen 1 2 3 4 , Maria Sammut 3 , Rebekah Pickering 2 , Jenelle Preece 2 , Anne Sweetapple 5 , Carlos Garcia‐Esperon 1 4 6 , John Attia 6 7 , Neil Spratt 1 5 8 , David Lambkin 7 , Daniel Barker 6 7 , Gillian Mason 7 , Gary Crowfoot 9 , Coralie English 1 3 , Kirsti Haracz 3 , Michael Nilsson 1 10 , Michael Pollack 10 11 , Lin Ong 8 , Frederick R Walker 1 8 , Frini Karayanidis 7 12 , Christopher Levi 1 5 6
  1. Heart and Stroke Program , Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
  2. Community Stroke Team, Hunter New England Local Health District, Newcastle, NSW, Australia
  3. School of Health Sciences, University of Newcastle, Newcastle, NSW, Australia
  4. Hunter Stroke Service, Hunter New England Local Health District, New Lambton Heights, NSW, Australia
  5. Hunter New England Health Local Health District, New Lambton Heights, NSW, Australia
  6. School of Medicine and Public Health, University of Newcastle, Newcastle, NSW, Australia
  7. Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
  8. School of Biomedical Sciences and Pharmacy, University of Newcastle , Newcastle, NSW, Australia
  9. School of Nursing and Midwifery, University of Newcastle, Newcastle, NSW, Australia
  10. Centre for Rehab Innovations, University of Newcastle, Newcastle, NSW, Australia
  11. Rehabilitation Medicine, Rankin Park Centre, Hunter New England Local Health District, Newcastle, NSW, Australia
  12. School of Psychological Sciences, Hunter New England Local Health District, Newcastle, NSW, Australia

Background: Recurrent stroke risk is high after a transient ischemic attack (TIA). Self-management of modifiable risk factors can contribute to significant improvements in cardiovascular health and reduce this risk.

Aim:  Determine the effect of participation in a health service delivered secondary prevention program on measures of TIA (& minor stroke) patients’ cardiovascular health.

Methods:  Non-randomised controlled trial where intervention group received 6 weeks of twice-weekly face-to-face education and exercise in a community gym followed by 12 weeks of telehealth health coaching. The control group received no treatment. Co-primary outcomes of (i) daily minutes in moderate-to-vigorous physical activity (MVPA) and (ii) systolic blood pressure (SBP) and secondary outcomes of cardiovascular health (e.g., blood sugar, cortisol and inflammation levels, lipid profile, waist-to-hip ratio, cognitive function, emotional distress, fatigue and quality of life) were measured at 6, 18 and 30 weeks. Differences were tested using generalized linear mixed models adjusting for age, gender and time post-stroke.

Results:  Participants (n=90) were recruited between 2017 and 2021. COVID related service restrictions prevented intervention delivery twice and contributed to an early trial close-out. Median time post-stroke event (intervention 121 days (83,209) vs control 1134 days (555, 2196) and male gender (62% vs 48%) differed between groups, but age (66.5 (12,0) vs 65.7 (11,3)) was similar.  There was no difference at 6 weeks between groups in MVPA (24.2 min [95%CI, 13.3-61.3]) or SBP (-0.4mmHg [95% CI, 4.2-3.3]). The intervention group reported a significant reduction in stress on the Depression, Anxiety and Stress Scale at 18 weeks (-2.9, [95% CI -5.7 - -0.2]) with a trend towards a reduction at 30 weeks (-3.7 [95%CI –7.4-0]).

Conclusion: This study is one of few evaluating the effects of a health service delivered secondary stroke prevention program. Results of this pandemic disrupted trial will inform future health service delivered face-to-face and virtual post-stroke prevention and self-management programs.