Culturally Tailored Skills-Based Intervention More Effective for Secondary-Stroke Prevention for Hispanic Patients
Although there are evidence-based interventions proven effective for reducing the incidence of a second stroke, repeat stroke is frequent, accounting for approximately 25% of all stroke. Repeat stroke is also more frequent among racial and ethnic minorities who already have higher rates of stroke overall. In the DESERVE trial (NCT01836354), a new culturally tailored and skills-based intervention was found to be more effective for Hispanic patients in controlling systolic blood pressure 1 year after a stroke. Systolic blood pressure reduction was used as the primary measure because evidence suggests it may be the most important risk factor for having a second stroke.(JAMA Neurol. 2018:October 8)
Hispanic patients who received the culturally-tailored skills-based intervention had a 9.9 mm Hg lower systolic blood pressure than Hispanic who received the standard-of-care intervention (range 1.8-18, CI 95%). This translates to almost a 40% risk reduction for these patients. Participants in the study from other ethnic groups had clinical decreases in systolic blood pressure that were not statistically different from standard intervention.
In this study, 281 women and 271 men (total = 552). Participants included 180 Hispanics (33%), 151 non-Hispanic whites (27%), and 183 non-Hispanic blacks (33%). All patients were enrolled while they were in 1 of 4 New York City hospitals after experiencing a mild to moderate stroke or transient ischemic attack (TIA). Participants were randomly assigned to receive current standard-of-care intervention for preventing a second stroke or to receive the new skills-based intervention.
The new treatment was developed at the request of participants in an earlier study, the SWIFT trial (NCT00415389) and participants in that trial contributed to the development of the DESERVE intervention. The DESERVE intervention includes interactive video narratives in which patients from the SWIFT trial talk about their experience recovering from stroke and a patient workbook. The interactive education focuses on patient-physician communication, particularly during the first postdischarge visit; medication adherence; and accurate risk estimation and reduction methods. A community health coordinator hired from the underlying patient population delivered the intervention including the 3 postdischarge phone calls.