Introduction: Access to specialized outpatient follow-up care after ischemic stroke can be limited by distance. We investigated the use of home telemedicine to monitor secondary stroke risk factors, as compared to traditional in-person stroke clinic follow-up.
Methods: Patients seen for management of ischemic stroke or TIA at a single institution were enrolled prior to discharge or at the time of a 7-day follow-up call. Participants who lived within a 75 mile radius were assigned to standard clinic follow up, and those who lived outside a 75 mile radius were assigned to telemedicine follow up. Patients were seen by a nurse and physician at 30 days, 90 days, and 1 year post discharge and blood pressures were taken at each visit. Outcomes assessed were those achieving a goal systolic blood pressure <140 mmHg (<130 mmHg if diabetic); low density lipoprotein <100 mg/dl; BMI <25 (if baseline BMI 25-27) or >10% weight loss if BMI >27; Physician based Assessment and Counseling for Exercise (PACE) score >3; knowledge of >2 stroke signs; patient adherence; and patient satisfaction with quality of care, coordination with primary care physician, and overall experience, as assessed via anonymous survey. A Fisher’s exact test, and a Wilcoxon rank sum test were used for statistical analysis at these three time points.
Results: 16 patients (63% male, mean age 63.1) were enrolled to clinic follow up, and 8 patients (50% male, mean age 62.5) were enrolled to telemedicine follow up. Adherence to follow up at 1 year post-stroke in the telemedicine cohort (87.5%) did not differ significantly from the clinic cohort (56.2%, p=0.189). The proportion of the telemedicine cohort (80%) and clinic cohort (50%) who met blood pressure goals at 1 year post-stroke did not differ significantly (p=0.180). Serum LDL, weight loss, exercise, knowledge of 3 or more stroke signs, and satisfaction scores similarly demonstrated no significant difference between the two cohorts.
Conclusion: Telemedicine may serve as an alternative to standard clinic follow-up in the management of secondary stroke risk factors in the outpatient setting.