Abstract Body: Background: Health education holds potential as a preventive measure for stroke recurrence. However, the evidence remains inconclusive. This study aimed to assess the effectiveness of a health education program in reducing stroke recurrence and related adverse events.
Methods: A hospital-based randomized controlled trial was employed in a tertiary hospital in Bangladesh. First stroke patients after discharge from the hospital, age ≥ 18 years, and mRS 0-4 were enrolled. Stratified by age and type of stroke, 432 patients were randomly allocated into the intervention group (IG) and the control group (CG). The IG received (self) management health education including blood pressure, medication, diet, and exercise monitoring for 12 months, and the CG received the usual care. The outcomes were recurrence and all adverse events related to stroke after 12-month follow-up.
Results: The IG (n=166) and the CG (n=141) completed the 12-month follow-up. A total of 26 (6.0%) patients had recurrence within 28 days of the first attack, and 47 (10.8%) died within the 1^st month. Stroke recurrence was observed in 14 patients (6.5%) in the IG and 8 (3.7%) in the CG after 28 days of the initial stroke (p=0.189). Stroke-related adverse events occurred in 116 patients (26.9%, IG: 25.0% and CG: 28.7%, p=0.294), including 95 deaths (22.0%) (18.1% in IG and 25.9% in CG, p=0.041). However, after adjusting for baseline stroke severity (mRS), neither overall events nor all-cause mortality showed significant differences (p=0.933 and p=0.341, respectively). The intervention in IG significantly improved the medication adherence of stroke patients at 6-month and 12-month intervals (p<0.001 and p=0.002, respectively).
Conclusions: Because of the high number of patients with severe mRS and the fact that many died or had recurrences in the first month, we were not able to prove the effectiveness of this health education. However, enhanced medication adherence brought by health education could reduce stroke-related adverse events if we follow long-term period. This study findings suggest the importance of improvement of acute care and health education programs to integrate into the health system for the management of stroke. Further research with large sample size can determine the influencing factors for the recurrence of stroke.