Abstract Details

Hypertension is the most important modifiable risk factor for recurrent stroke. Yet it remains poorly controlled after stroke, especially among Black and Hispanic patients. Interventions that promote equitable access are needed to improve outcomes.

To test feasibility of a randomized trial of a post-acute stroke care model, Telehealth After Stroke Care (TASC), that integrates nurse-supported home BP telemonitoring, tailored BP infographics, and video visits with a multidisciplinary team.

Acute stroke patients with hypertension were randomized prior to discharge. Usual care patients received video visits with primary care at 1-2 weeks then stroke at 6 and 12 weeks. TASC patients received usual care plus a home BP device and tablet with wireless transmission to the electronic medical record. Feasibility outcomes included recruitment, retention and visit adherence. Within-patient home Systolic BP (SBP) change was analyzed using generalized linear regression.

Of 67 eligible patients, 8 declined. Fifty enrolled patients were 44% Hispanic, 32% Black and 36% women with mean age 64.3 (±14.0) yrs. Half had up to high school education and 39% had Medicaid or no insurance. Overall retention rate exceeded 70% and video visit adherence was nominally higher in TASC. Baseline SBP was similar in TASC (140 ± 19 mmHg) vs. usual care (142 ± 19 mmHg). At 12 weeks, home SBP declined by 16 ± 19 mmHg from baseline in TASC vs. increased by 3 ± 24 mmHg (p = 0.01) in usual care. SBP control ≤130 mmHg was better in TASC vs. usual care (76% vs. 25%, p < 0.01), and among Black patients improved from 40% to 100% in TASC vs. 14% to 29% in usual care.

Enhancing post-acute stroke care with nurse and pharmacist-supported home BP telemonitoring is a promising approach to improve BP control in an underserved setting that should be tested in a definitive randomized trial.