Derivation and Application of a Tool to Estimate Benefits From Multiple Therapies That Reduce Recurrent Stroke Risk.
Derivation and Application of a Tool to Estimate Benefits From Multiple Therapies That Reduce Recurrent Stroke Risk.
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推导和应用一种工具来估计降低复发性中风风险的多种疗法的益处。
DOI：
10.1161/strokeaha.119.027160
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发表时间：
2020
期刊：
影响因子：
8.3
通讯作者：
Vickrey,BarbaraG
中科院分区：
文献类型：
--
作者：
Richards,Adam;Jackson,NicholasJ;Cheng,EricM;Bryg,RobertJ;Brown,Arleen;Towfighi,Amytis;Sanossian,Nerses;Barry,Frances;Li,Ning;Vickrey,BarbaraG
背景和目的降低血压和胆固醇、抗血小板/抗血栓药物的使用和戒烟可降低中风复发的风险。然而，中风幸存者在风险因素控制方面的差距需要开发和评估旨在同时改善多种风险因素的替代护理提供模式。护理提供模式的随机试验很少有足够的持续时间或规模来支持低频率结果，如观察到的复发性中风。这就需要工具来评估多个中风危险因素的变化如何降低中风复发的风险。方法我们回顾了现有的证据，证明了针对降低血压、降低胆固醇、抗血小板/抗血栓药物使用和戒烟的干预措施的有效性，并提取了每种干预措施的相对风险。从这一点出发，我们开发了一种工具，使用自举和模拟方法来估计复发中风风险的减少。我们还计算了一个修正的全球结果评分，代表了如果所有4个个体风险因素都得到最佳控制，潜在收益(相对风险降低)的比例。我们应用该工具评估了275名参与者的中风风险降低，这些参与者拥有来自最近发表的针对多个中风风险因素的医疗保健提供模型的随机试验的完整12个月随访数据。结果反复中风风险工具是可行的，在试验组和常规护理试验组中，缺血性中风的相对风险估计降低了0.36。全球结果评分结果显示，平均而言，两组参与者可能避免了45%的复发中风事件，这些事件本可以通过对所有4个单独风险因素进行最大限度的干预来预防。结论中风风险降低工具有助于估计多种中风风险因素改善对血管风险的综合影响，并为测试替代护理模式预防复发中风的研究提供总结结果。注册URL：https://www.clinicaltrials.gov；唯一标识符：NCT00861081。
Background and PurposeLowering blood pressure and cholesterol, antiplatelet/antithrombotic use, and smoking cessation reduce risk of recurrent stroke. However, gaps in risk factor control among stroke survivors warrant development and evaluation of alternative care delivery models that aim to simultaneously improve multiple risk factors. Randomized trials of care delivery models are rarely of sufficient duration or size to be powered for low-frequency outcomes such as observed recurrent stroke. This creates a need for tools to estimate how changes across multiple stroke risk factors reduce risk of recurrent stroke.MethodsWe reviewed existing evidence of the efficacy of interventions addressing blood pressure reduction, cholesterol lowering, antiplatelet/antithrombotic use, and smoking cessation and extracted relative risks for each intervention. From this, we developed a tool to estimate reductions in recurrent stroke risk, using bootstrapping and simulation methods. We also calculated a modified Global Outcome Score representing the proportion of potential benefit (relative risk reduction) achieved if all 4 individual risk factors were optimally controlled. We applied the tool to estimate stroke risk reduction among 275 participants with complete 12-month follow-up data from a recently published randomized trial of a healthcare delivery model that targeted multiple stroke risk factors.ResultsThe recurrent stroke risk tool was feasible to apply, yielding an estimated reduction in the relative risk of ischemic stroke of 0.36 in both the experimental and usual care trial arms. Global Outcome Score results suggest that participants in both arms likely averted, on average, 45% of recurrent stroke events that could possibly have been prevented through maximal implementation of interventions for all 4 individual risk factors.ConclusionsA stroke risk reduction tool facilitates estimation of the combined impact on vascular risk of improvements in multiple stroke risk factors and provides a summary outcome for studies testing alternative care models to prevent recurrent stroke.RegistrationURL: https://www.clinicaltrials.gov; Unique identifier: NCT00861081.