Program to Avoid Cerebrovascular Events Through Systematic Electronic Tracking and Tailoring of an Eminent Risk-factor (PACESETTER)

在中风护理和预后方面的种族和城乡差异在 美国东南部地区，那里的3个州长期以来被认为代表着 “中风带”，即在一个已经负担更重的更广泛的区域内，高度容易中风的三州地区 与这个国家的其他地区相比，中风的发病率更高。南卡罗来纳州是这3个州中的一个。幸运的是，中风 高血压(HTN)是中风的首要可改变的危险因素，但较少 超过三分之一的最近中风患者的血压(BP)在75%的时间内得到了≥的控制，而且 血压控制的一致性低与未来发生重大血管事件的风险较高有关。负责的关键因素 对于非裔美国人(AA)失控的HTN，是药物不依从性和未能加强 及时进行治疗。因此，根据文化量身定做的有效的血压控制计划 是可接受的、可行的、及时的和可持续的，特别是在高血压中风幸存者中 谁住在划船扣上，或者谁是AA。移动健康(MHealth)技术提供了一种前景看好的 解决这一需求的方法。预防脑血管事件计划的总体目标 通过系统的电子跟踪和定制显著的风险因素(标兵)研究是 展示以理论模型为基础、以mHealth技术为中心的多层次集成方法 可有效实施以改善南方中风患者的持续血压控制 卡罗莱纳州(其中至少一半将是AA)在中风症状出现后一个月内。其主要目的是 进行标兵干预的实施试验(在患者层面)[卫生技术 (个性化电话短信和家庭血压监测)]与200例近期中风患者的常规护理 在南卡罗来纳州的三家主要安全网医院招募高血压患者(在 查尔斯顿、哥伦比亚和格林维尔)。主要结果将是实现指南建议的目标 在12个月时控制收缩压。我们的目标也是探讨是否实施 心脏起搏器干预与标准护理相比与随后心血管疾病的减少相关 与事件相关的再住院，显示出在减少实际血管事件方面的潜在疗效的信号，以及 对护理中风患者的提供者有明显的影响。总而言之，标兵干预，如果 被证明是有效和可实施的，最终可能会出口到其他医疗服务不足的人群 在美国，Beyond SC是一种可行的循证中风后管理模式。

Racial and rural-urban disparities in stroke care and outcomes are most prominent in the Southeastern region of the US, where 3 states have long been recognized as representing the `buckle' of a `stroke belt', i.e. highly stroke-prone tri-state area within a broader region already more heavily burdened with stroke compared to the rest of the country. One of these 3 states is South Carolina (SC). Fortunately, stroke is eminently preventable and hypertension (HTN) is the premier modifiable risk factor for stroke, but fewer than one third of patients with a recent stroke have their blood pressure (BP) controlled ≥75% of the time and low consistency of BP control is linked to higher risk of future major vascular events. Key factors responsible for uncontrolled HTN in African Americans (AA) are medication non-adherence and failure to intensify therapy in a timely manner. As such, culturally-tailored, efficacious blood pressure control programs which are acceptable, feasible, timely, and sustainable are needed, especially among hypertensive stroke survivors who reside in the stroke buckle or who are AA. Mobile health (mHealth) technology offers a promising approach to address this need. The overall objective of the Program to Avoid Cerebrovascular Events through Systematic Electronic Tracking and Tailoring of an Eminent Risk-factor (PACESETTER) study is to demonstrate that a theoretical-model- based, mHealth technology-centered, multi-level integrated approach can be effectively implemented to improve sustained BP control among stroke patients encountered in South Carolina (at least half of whom will be AA) within one month of stroke symptom onset. The primary aim is conduct an implementation trial (at the patient level) of the PACESETTER intervention [health technology (personalized phone text messaging and home BP monitoring)] vs. usual care in 200 recent stroke patients with hypertension recruited across the three main safety net hospitals in the state of SC (in the cities of Charleston, Columbia, and Greenville). Primary outcome will be achievement of guideline-recommended systolic blood pressure control at 12 months. We also aim to explore whether implementation of the PACESETTER intervention vs. standard care is associated with a reduction in subsequent cardiovascular event-related re-hospitalizations, shows a signal of potential efficacy in reducing actual vascular events, and has distinct effects on providers caring for patients with stroke. Altogether, the PACESETTER intervention, if proven effective and implementable, may eventually be exported to other medically underserved populations in the US beyond SC, as a feasible model of evidence-based post-stroke management.