Introduction: Secondary stroke prevention strategies have proven suboptimal in underserved communities and minority populations.
Methods: The Discharge Educational Strategies for Reduction of Vascular Events (DESERVE) trial tested the efficacy of an innovative skills-based intervention focused on risk perception, medication adherence, and patient-physician communication (vs. usual care enhanced with educational material [EUC]) on blood pressure (BP) reduction among mild/moderate stroke (NIH Stroke Scale ≤ 15) or TIA patients at 1 year post discharge. Study participants were stratified by interview language (English/Spanish) and randomized to intervention or EUC. BP reduction was the difference between systolic BP at baseline and 1-year post-discharge. We assessed differences in baseline characteristics and mean BP reduction between trial arms, overall and by race/ethnicity. Linear regressions evaluated mean difference in blood pressure reduction between trial arms, adjusting for characteristics that differed between trial arms at baseline and language of interview.
Results: To date, 290 of 552 stroke/TIA patients recruited at baseline (25% white, 32% black, 36% Hispanic) were evaluated at 1 year (n=145 in each arm). Overall, there was a trend toward greater mean BP reduction in the intervention vs. EUC group (9.3 vs. 6.0 mmHg, p=0.259). Mean BP reduction was significantly greater in the intervention vs. EUC group among Hispanics (9.9 vs. -0.7 mmHg, p=0.040). Among Hispanics, after adjusting for interview language, sex, and place of birth, mean BP reduction was 10.9 mmHg greater in the intervention vs. EUC group (p=0.041). Mean BP reduction did not differ significantly between trial arms among non-Hispanics. We are currently gathering information to evaluate the impact of the intervention on secondary stroke incidence.
Conclusions: Few behavioral intervention studies in stroke survivors have reported significant differences in vascular risk reduction in the longer term, and fewer have focused on a skills-based approach. Culturally-tailored, skills-based interventions may be more useful than knowledge-focused interventions in achieving sustained vascular risk reduction and addressing race/ethnic disparities in stroke.