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

通过系统电子跟踪和调整显着风险因素来避免脑血管事件的计划 (PACESETTER)

• 批准号: 9471152
• 负责人: BRUCE OVBIAGELE
• 金额: $ 65.53万
• 依托单位: MEDICAL UNIVERSITY OF SOUTH CAROLINA
• 依托单位国家: 美国
• 财政年份: 2017
• 资助国家: 美国
• 起止时间: 2017-09-20 至 2022-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9471152
• 关键词: Accident and Emergency department; Achievement; Address; Adherence; African American; Area; Blood Pressure; Blood Vessels; Car Phone; Cardiovascular system; Caring; Cause of Death; Cellular Phone; Cessation of life; Cities; Clinic Visits; Country; Data; Death Rate; Dementia; Ethnography; Event; Failure; Future; Goals; Guidelines; Health; Health Communication; Health Technology; Home Blood Pressure Monitoring; Home environment; Hospitalization; Hospitals; Hypertension; Incidence; Intervention; Ischemic Stroke; Link; Medical; Modeling; Monitor; Myocardial Infarction; Not Hispanic or Latino; Outcome; Patient Care; Patients; Pharmaceutical Preparations; Phonation; Prevalence; Prevention strategy; Provider; Public Health; Race; Randomized Controlled Trials; Recruitment Activity; Reporting; Research; Rest; Risk; Risk Factors; Rural; Self Blood Pressure Monitoring; Self Management; Signal Transduction; South Carolina; Stroke; Stroke prevention; Surveys; Symptoms; System; Telephone; Testing; Text; Theoretical model; Therapeutic; Time; United States; Universities; base; blood pressure regulation; cerebrovascular; clinical efficacy; disability; ethnic minority population; evidence base; experience; forgetting; high risk; hypertension control; implementation trial; improved; indexing; mHealth; medically underserved population; medication compliance; modifiable risk; mortality; pill; population based; post stroke; primary outcome; programs; safety net; standard care; stroke survivor; stroke symptom; systematic review; telehealth; treatment as usual; urban disparity; virtual; willingness

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.

中风护理和结果的种族和城乡差异在以下人群中最为突出： 美国东南部地区，其中三个州长期以来一直被认为代表了一个国家的“扣”。 “中风带”，即在一个更广泛的地区内高度中风易发的三州地区， 与全国其他地区相比，其中一个州是南卡罗来纳州。幸运的是中风 高血压（HTN）是中风的首要可改变的危险因素， 超过三分之一的近期卒中患者的血压（BP）控制≥75%， 血压控制的低一致性与未来主要血管事件的高风险有关。关键因素 非裔美国人（AA）中不受控制的HTN是药物不依从性和未能加强 及时治疗。因此，文化定制的，有效的血压控制计划， 是可接受的，可行的，及时的，可持续的，特别是在高血压卒中幸存者中。 谁住在中风扣或谁是AA。移动的健康（mHealth）技术提供了一个有前途的 方法来满足这一需求。避免脑血管事件计划的总体目标 通过系统电子跟踪和调整突出风险因素（PACESETTER）研究， 证明了一种基于理论模型、以移动健康技术为中心的多层次综合方法 可以有效地实施，以改善在南方遇到的中风患者的持续血压控制 中风症状出现后一个月内，卡罗莱纳（其中至少一半为AA）。主要目的是 进行PACESETTER干预[卫生技术]的实施试验（在患者层面） （个性化电话短信和家庭血压监测）]与200例近期卒中患者的常规治疗相比 南卡罗来纳州三家主要安全网医院招募的高血压患者（ 查尔斯顿、哥伦比亚和格林维尔）。主要结局将是实现指南推荐的 12个月时收缩压控制。此外，我们亦会探讨实施 与标准治疗相比，起搏器干预与后续心血管事件减少相关 事件相关再住院，显示出减少实际血管事件的潜在疗效信号，以及 对照顾中风病人的提供者有明显的影响。总而言之，起搏器干预，如果 被证明有效和可实施，最终可能会出口到其他医疗服务不足的人群， 在美国，除了SC，作为一种可行的循证中风后管理模式。