Does a Culturally Tailored Intervention Reduce Long-Term Vascular Risk in Minorities?

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Participants in both groups were roughly equally distributed across racial/ethnic groups.
Participants in both groups were roughly equally distributed across racial/ethnic groups.

The Discharge Educational Strategies for Reduction of Vascular Events (DESERVE) intervention, a skills-based and culturally tailored behavioral intervention composed of educational initiatives focused on effective patient-physician communication, adherence to medication, and stroke risk perception with risk reduction skills, was associated with blood pressure reduction by 1 year in Hispanic patients hospitalized with mild/moderate stroke and transient ischemic attack, according to a study published in JAMA Neurology.

In a 2-group randomized controlled trial (ClinicalTrials.gov identifier: NCT01836354), patients from 4 New York City medical centers who had an emergency department visit or hospitalization with mild/moderate stroke and transient ischemic attack were prospectively enrolled. Study researchers randomly assigned patients to either usual care (n=278) or DESERVE intervention (n=274). Primary outcome was reduction in systolic blood pressure at 12 months after hospital discharge from baseline. Blood pressure at baseline was taken ≥48 hours after stroke, up to 3 times.

At 12 months after discharge, there was no difference between the DESERVE intervention and usual care groups in regard to systolic blood pressure reductions (β, 2.5 mm Hg; 95% CI, −1.9 to 6.9 mm Hg). In Hispanic patients, however, a 9.9 mm Hg (95% CI, 1.8-18.0 mm Hg) greater mean systolic blood pressure reduction was observed among those receiving the DESERVE intervention vs those in the usual care group. Despite this difference, in the subgroup analysis, the researchers observed no differences between non-Hispanic white (β, 3.3; 95% CI, −4.1 to 10.7) and non-Hispanic black (β, −1.6; 95% CI, −10.1 to 6.8) patients in terms of the primary outcome.

A limitation of the study includes the partial reliance on physician records vs in-person visits for collecting follow-up blood pressure measurements.

Findings from this trial indicate "that culturally tailored, skills-based interventions may be more useful than knowledge-focused interventions in achieving sustained vascular risk reduction and addressing racial/ethnic disparities in stroke; however, these findings should be tested in future studies."

Reference

Boden-Albala B, Goldmann E, Parikh NS, et al. Efficacy of a discharge educational strategy vs standard discharge care on reduction of vascular risk in patients with stroke and transient ischemic attack: The DESERVE Randomized Clinical Trial [published online October 8, 2018]. JAMA Neurol. doi: 10.1001/jamaneurol.2018.2926

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