Stroke: Study Examines Risk of Recurrence

07/17/2023

In a large-scale study, research teams from the University of Würzburg and the Ludwigshafen Municipal Hospital have investigated whether risk of stroke recurrences can be reduced by a structured outpatient follow-up care program.

Every year, about 70,000 people in Germany suffer a so-called stroke recurrence - that is, a second stroke after a previous one. (Image: peterschreiber.media / istockphoto.com)

The risk of stroke recurrence is substantial: about 70,000 people are suffering from a recurrent stroke in Germany every year, often with serious consequences for those affected. There are a number of established risk factors that increase the risk of recurrent stroke with high blood pressure, smoking and hypercholesterolemia - i.e. elevated blood fat levels - are the most important ones.

It is estimated that improved control of these risk factors could prevent about half of the recurrent stroke events. To achieve optimal stroke prevention, however, systematic treatment concepts for long-term outpatient stroke care are lacking in Germany.

Structured outpatient aftercare

In cooperation with the Institute for Clinical Epidemiology and Biometry at the Julius-Maximilians-Universität Würzburg (JMU), the Ludwigshafen Hospital therefore conducted the study "The structured ambulatory post-stroke care program for outpatient aftercare in patients with ischaemic stroke in Germany" (SANO). The aim of the project was to improve the long-term care of patients after a stroke and, thus, to reduce the risk of stroke recurrence as well as to achieve a better quality of outpatient care.

For this purpose, a structured aftercare programme was established in the intervention regions, which included regular outpatient aftercare appointments with a specialized treatment team covering various aspects of stroke aftercare. In addition, comprehensive local treatment network were established consisting of therapists and specialists from various disciplines and other health care providers.

The research team has now published the results in the journal The Lancet Neurology. A total of 2,791 patients at 30 partner hospitals with supraregional stroke units in southern and western Germany took part in the project, which was funded by the Innovation Fund of the Federal Joint Committee (G-BA) with about 5.8 million euros.

Improved control of risk factors

Dr Christopher Schwarzbach, coordinator of the SANO project and senior physician at the Neurological Clinic of the Ludwigshafen Municipal Hospital, and Professor Armin Grau, former director of the Neurological Department of the Ludwigshafen Municipal Hospital who initiated the study, comment on the results as follows: "Within the framework of SANO, an improved control of specific vascular risk factors could be achieved, however, the one-year follow-up did not yet show a reduction in the risk of stroke recurrences. An examination of the long-term effects of the SANO study on the risk of stroke recurrence is therefore already in preparation. Other effects of the SANO project on the risk of falls, depression and other stroke sequelae, as well as the quality of life of those affected, also still need to be assessed."

Professor Peter Heuschmann, chair of the Institute of Clinical Epidemiology and Biometry, adds: "Thanks to the great commitment of all those involved - at the centre level as well as at the coordination and evaluation - we were able to perform the SANO study successfully despite the limitations of the Corona pandemic. The results of SANO show that complex intervention studies can be successfully conducted and evaluated with the participation of numerous different institutions in routine care in Germany."

Original publication

“The structured ambulatory post-stroke care program for outpatient aftercare in patients with ischaemic stroke in Germany (SANO): an open-label, cluster-randomised controlled trial”. Christopher J Schwarzbach, MD, Felizitas Anna Eichner, MSc, Viktoria Rücker, PhD, Anna-Lena Hofmann, MSc, Moritz Keller, MD, Prof Heinrich J Audebert, MD, et al. https://doi.org/10.1016/S1474-4422(23)00216-8