Importance and Challenges of Moving Stroke Prevention into the Community
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See Article by Cheng et al
Stroke is a leading cause of morbidity and mortality in the United States and disproportionally affects minority populations, especially blacks and Hispanics.1 Hence, the importance of the recent study conducted by Cheng et al; they describe the results of a randomized controlled trial testing the efficacy of a multicomponent Chronic Care Model–based intervention among patients receiving care within the Los Angeles, California, public healthcare system2. This is the second largest municipal healthcare system in the United States with a high penetration of minority patients, including many non-English speakers.
The SUSTAIN trial (Systematic Use of Stroke Averting Interventions) tested a complex intervention to address risk factors for stroke. The SUSTAIN intervention included multiple elements—group visits, one-on-one sessions with a care manager to individualize and reinforce the content presented in the group session, clinical visits, and home blood pressure monitoring—compared with an educational control. SUSTAIN’s primary outcome was improvement in systolic blood pressure at 12 months. Secondary outcomes included improvement in cholesterol control, specifically low-density lipoprotein, also at 12 months. Although the study was adequately powered, the primary outcome results were null. Systolic blood pressure decreased in both the intervention and control arms, but the difference in improvement between the groups (−3.6 mm Hg) was not statistically significant.2
To advance the field of stroke prevention and ensure that a balanced view is presented in the literature, publishing both positive and null studies is important. Despite the null findings, SUSTAIN had several noteworthy aspects. The study was conducted in a community healthcare system and enrolled a large proportion of …