Primary Care-Based Digital Health-Enabled Stroke Management Intervention: Long-Term Follow-Up of a Cluster Randomized...

Area of Science:

• Neurology
• Public Health
• Health Services Research

Background:

• Multicomponent primary care interventions show short-term benefits for stroke management, but long-term effects remain unproven.
• Stroke prevalence is high in China, particularly in areas with suboptimal healthcare resources.

Purpose of the Study:

• To evaluate the long-term outcomes of a system-integrated technology-enabled model of care (SINEMA intervention) for stroke.
• Assess effects on systolic blood pressure (BP) and other secondary outcomes in Chinese stroke patients.

Main Methods:

• An open-label, cluster randomized clinical trial involving 50 villages in China with a 1-year intervention and long-term follow-up (5.5 years).
• Intervention included training, incentives, mobile health tools for village doctors, and daily patient voice messages.
• Intention-to-treat analyses compared changes in systolic BP and secondary outcomes between intervention and control groups.

Main Results:

• The intervention group showed a significant reduction in systolic BP (-2.8 mm Hg) and stroke recurrence (risk ratio 0.77) at 5.5 years.
• Lasting effects were observed for most secondary outcomes, including BP control and medication adherence.
• Benefits were more pronounced in women and individuals with lower socioeconomic status.

Conclusions:

• A 1-year technology-enabled intervention demonstrated sustained benefits in reducing systolic BP and stroke recurrence.
• The findings provide evidence for long-term health and inequity-reducing effects of the SINEMA intervention.
• The intervention holds promise for implementation in resource-limited settings for stroke management.