[Prevention of stroke and dementia in general practice: evaluation of the project INVADE]

Stroke and dementia have several modifiable risk factors in common. In the primary care prevention project INVADE (INtervention project on VAscular brain diseases and Dementia in the district of Ebersberg), these vascular risk factors were recorded systematically and treated according to evidence-based guidelines.

All insurants of the AOK Bayern who were ≥ 50 years of age and lived in the Upper Bavarian district of Ebersberg received the offer to participate in INVADE, about one-third enrolled in the program. Examinations by the family doctor, self-reports of the participants, laboratory analyses, and a duplex sonography of the extracranial neck vessels were used to create individual risk profiles, from which the intervention measures were derived. GPs documented the treatment and health status of the participants at quarterly intervals. The entire examination program was repeated every two years. The success of the intervention was determined in comparison with the district of Dachau, where the insurants received the primary care treatment as usual. Administrative data of the health and long-term care fund for the period from 2013 to 2016 were used as clinical endpoints. Primary endpoints included mortality and onset of long-term care, secondary endpoints were inpatient treatments due to cerebrovascular disease.

The comparison between the district of Ebersberg (N = 10.663) and the district of Dachau (N = 13.225) was in favor of the prevention program for both the primary clinical endpoints and the combined secondary endpoint. Mortality risk (HR = 0.90; 95 % confidence interval: 0.84-0.97), long-term care risk (HR = 0.88; 0.81-0.96), and the likelihood of inpatient treatment for cerebrovascular disease (OR = 0.87; 0.77-0.97) were significantly reduced.

The results support the assumption that the incidence of cerebrovascular disease and dementia can be reduced by a systematic general-practice based identification and treatment of vascular risk factors and can thus increase life expectancy and disability-free life time.

clinicaltrials.gov, NCT1107548, registration date: 21.04.2010, drks.de, DRKS00011348, registration date: 29.12.2016.