Discharge Educational Strategies for Reduction of Vascular Events

Stroke and its risk factors disproportionately affect minority populations, and secondary
stroke prevention programs have had relatively little success. TIA and mild stroke patients
with few after-affects also stay in the hospital for a shorter period of time, and leave
without enough information about their risk for another stroke. Additionally, mild stroke and
TIA patients often do not follow-up with neurologists after they leave the hospital. DESERVE
is a discharge education study using health workers to enroll and randomly assign 800
subjects from MSSM, MSSM Queens and CUMC diagnosed with Transient Ischemic attack (TIA ),
mild Ischemic stroke (IS) or mild Intracerebral Hemorrhage (ICH) to either risk factor
education or usual care. Those patients assigned to education will receive education on
stroke preparedness education plus risk factor reduction education, and help accessing follow
up care with health workers. This education includes a power point presentation and a
patient-paced workbook and video on Risk perception, Medication Adherence, and
Patient-Physician Communication. To target the most appropriate mild IS/ICH and TIA survivors
for participation in this proposal, we will focus on survivors with mild stroke and TIA,
excluding those whose stroke deficits are severe enough to warrant discharge to a nursing
home or to require 24-hour care.

Those patients assigned to usual care will receive written stroke preparedness education.
This protocol will evaluate the effectiveness of this intervention to reduce blood pressure,
and individual stroke risk factors and future stroke risk. Additionally, we will evaluate the
ability of the these strategies to conduct education to affect positive change in taking
medications as directed, stroke knowledge 6 months and 12 months after hospital admission,
attendance at follow-up health care appointments, and cost-effectiveness. After 1 year
participants will be followed quarterly for up to 3 years to track events.

Inclusion Criteria:

- Diagnosed with mild ischemic cerebral infarction or mild intracerebral hemorrhage
(NIHSS < 5) or TIA based on a clinical definition of focal neurologic deficits
consistent with a single vascular territory of the brain

- Aged greater than 18 years at onset of event

- Resident of NY Metropolitan community in home with land or cell phone.

- Vascular risk factors including HTN history or elevated blood pressure (>130/85 mmHg)
at the time of discharge, smoking, diabetes or metabolic syndrome

- Discharge to home

- English or Spanish Speaker

Exclusion Criteria:

- Patients unable to give informed consent

- Discharged to long-term nursing home or requiring 24 hour care.

- A Modified Rankin score > 2 at baseline

- Pre-stroke dementia history.

- Patients with end stage cancer, or other medical conditions resulting in mortality
less than 1 year.

- Patient does not speak English or Spanish.