Stroke-Card Registry
Stroke-Card Registry
Stroke is the second leading cause of death and one of the main contributors to disability.
 Patients who survive the acute phase of ischemic stroke and those with transient ischemic
 attack (TIA) are at high risk of subsequent vascular events. Importantly, recurrent strokes
 are associated with a higher social and economic impact, higher case fatality, and worse
 clinical outcome than first-ever strokes. The burden of post-stroke complications, residual
 deficits, and inadequate medical and psychosocial care all contribute to long-term disability
 and reduced quality of life in these patients. The Department of Neurology of the Medical
 University Innsbruck undertook the STROKE-CARD trial (NCT02156778) between 2014 and 2018 with
 follow-up until 2019 to evaluate the efficacy of the Post-Stroke disease-management program
 STROKE-CARD care. After implementation of STROKE-CARD care, the investigators aim to document
 the quality of post-stroke care and compare outcome parameters to historical cohorts and the
 change over time. Furthermore the investigators aim to gain a large data-resource for future
 research of biomarkers, disease mechanisms, prognosis and imaging mechanisms for R&D.
Stroke is the second leading cause of death and one of the main contributors to disability.
 Patients who survive the acute phase of ischemic stroke and those with a transient ischemic
 attack (TIA) are at high risk of subsequent stroke. Importantly, recurrent strokes are
 associated with a higher social and economic impact, higher case fatality, and worse clinical
 outcome than first-ever strokes. The burden of post-stroke complications, residual deficits,
 and inadequate medical and psychosocial care all contribute to long-term disability and
 reduced quality of life in these patients. Furthermore, effects on quality of life and
 long-term functional independence are particularly under-investigated.

 The Department of Neurology of the Medical University Innsbruck undertook the STROKE-CARD
 trial (NCT02156778) between 2014 and 2018 with follow-up until 2019 to evaluate the efficacy
 of the Post-Stroke disease management program STROKE-CARD care. The aim is to evaluate this
 program in a large multicenter cohort and to establish a biobank of stroke and TIA-patients
 for future research and development projects.

 In brief, the pragmatic and easily implementable STROKE-CARD care program reduced
 cardiovascular risk and improved health-related quality of life and functional outcome in
 patients with acute ischemic stroke or TIA in a timeframe of 12 months after the index event.
 To investigate the effects of STROKE-CARD care on a large basis and over a longer period, an
 evaluation of approximately 5,000 patients is warranted.

 Whereas disease management programs typically rely on expert opinion, the STROKE-CARD
 initiative moved from a purely empirical approach to a highly structured, individualized, and
 evidence-based procedure with professional outcome analysis. The STROKE-CARD concept will be
 implemented in clinical practice and can serve as a model for other disease management
 initiatives.

 Acute and short-term management of stroke and TIA has improved tremendously over the past
 years with substantial advances in acute therapy, implementation of comprehensive pathways
 for stroke and TIA, and approval of novel highly effective preventive treatments. As a main
 unmet challenge in stroke medicine, strategies of long-term care have to be developed and
 rigorously tested in order to maintain improved short-term patient outcome in the long run.

 STROKE-CARD care reduced the one-year cumulative absolute risk of CVD and ameliorated the
 patients' health-related quality of life at 12 months (EQ-5D-3L overall utility score,
 P<0.001). These findings were consistent in subgroups according to age, sex, and index event
 and were robust in the per-protocol analysis. Among pre-specified secondary outcomes assessed
 at 12 months, the investigators observed improvements in all individual dimensions of the
 EQ-5D-3L and in one-year functional outcome, that each met the multiplicity-adjusted
 threshold for statistical significance. Only a few previous trials of disease management
 programs in stroke and TIA patients have focused on recurrent CVD or quality of life as
 primary or secondary endpoints and none has considered long-term functional outcome after one
 year. The previous trial was limited to a 12-month follow-up in selected individuals and the
 sustainability of benefits of STROKE-CARD care in a large nationwide cohort over a longer
 follow-up period remains to be determined.

 This study aims to detect post-stroke complications, to estimate the patient's demand for
 nursing services, and support guideline-compliant secondary prevention with full achievement
 of target levels, lifestyle modifications, and in-person outcome assessment at 3 and 12
 months after the index-event, assessment of functional status (impairment), activity
 (disability), and participation (handicap and health-related quality of life). Additionally,
 yearly follow-up telephone interviews for cardiovascular outcome and health parameters will
 be conducted. In case of clinically indicated in-person follow-ups, the interviews will be
 done in person during the clinical visits. After the implementation of STROKE-CARD care, the
 investigators aim to document the quality of post-stroke care and compare outcome parameters
 to historical cohorts and the change over time. Furthermore, the investigators aim to gain a
 large data resource for future research of biomarkers, disease mechanisms, prognosis and
 imaging mechanisms for R&D.

 The main objective is to evaluate the Post-Stroke Disease Management program STROKE-CARD in a
 large multicenter cohort of stroke and TIA-patients and to establish a large clinical
 well-defined cohort. Furthermore, the investigators aim to gain a large data resource for
 future research of biomarkers, disease mechanisms, prognosis and imaging mechanisms for R&D.

 To document and monitor the quality of the Post-Stroke Disease Management program in
 different centers and compare outcomes to the historical cohort, as well as other published
 data. Furthermore, the investigators aim to constantly improve post-stroke care. This
 registry can facilitate to monitor and document the effect on the primary and secondary
 outcomes.

 There will be no formal safety endpoints in this study. No experimental procedures will be
 applied to patients and most of the procedures done are within the clinical routine.
 Potential side effects of optimal secondary stroke prevention are recorded.
Inclusion Criteria:

 -  Patients with acute ischemic stroke or high-risk TIA (ABCD2-Score ≥ 4 points) in the
 last 30 days

 -  Age ≥ 18 years

 -  Written informed consent

 Exclusion Criteria:

 -  Patients living outside the catchment area of the participating centers

 -  Patients under law enforcement or within mandatory military service

 -  Age < 18 years