Service change and Supporting Lifestyle and Activity Modification after Transient Ischaemic Attack (S+SLAM-TIA): Measuring the value of implementing an evidence based secondary stroke prevention program into a health service

Dr Heidi Janssen1,2,3, Mr Chris Catchpole1, Ms Anne Sweetapple1, Ms Gillian Mason3, Ms Diana Colvin2, Ms Anjelica Carlos1, A/Prof Coralie English2, Prof Louise Ada4, Prof Robin Callister2, Ms Maria Sammut2, Mr Tony Edser5, Dr Carlos Garcia Esperon1, Ms Michelle Russell1, Mr Ashley Young1, Dr Dianne Marsden1, Ms Ena Fisher1, Dr Peter MacIsaac3, Dr Gary Crowfoot2, Prof Frini Karayanidis2, A/Prof Frederick Rohan Walker2, Dr Lin K Ong2, Ms Monique Hourne1, Prof Andrew Searles3, Prof John Attia3, Mr Jonathan  Holt1, Prof John Wiggers1, Ms Rhonda Walker1, Ms Derene Anderson1, A/Prof Michael Pollack1, Prof Neil James Spratt1, Prof Michael Nilsson2, Dr Kirsti Haracz2, Prof Christopher Levi6

1Hunter New England Local Health District, Newcastle, Australia, 2University of Newcastle, Newcastle, Australia, 3Hunter Medical Research Institute, Newcastle, Australia, 4The University of Sydney, Sydney, Australia, 5Planet Fitness Health Clubs, Newcastle, Australia, 6The Sydney Partnership for Health, Education, Research & Enterprise (SPHERE), Sydney, Australia

Background: Patients are at greater risk of having recurrent cardiovascular events within 5 years after transient ischaemic attack (TIA). Despite the evidence that participation in a secondary stroke prevention program significantly reduces recurrent stroke risk, no such programs were available to NSW Health TIA patients. The Hunter New England Local Health District’s (HNELHD) Community Stroke Team sought to address this service gap.

Method: The Supporting Lifestyle and Activity Modification after TIA (SLAM-TIA) pilot program was developed utilising existing HNELHD resources and telehealth services. It was delivered in a community gym and supported patient self-management of stroke risk reduction through group education and exercise. Evaluation of this pilot program informed the non-randomised controlled trial currently underway, Service change +SLAM-TIA (S+SLAM-TIA). S+SLAM-TIA will determine the effect at a patient and service level of implementation of the SLAM-TIA program. The aim is to detect a 0.5SD difference (Cohen’s d=0.5) between groups in the co-primary outcomes of time in moderately-vigorous physical activity (MVPA) (accelerometry) and systolic blood pressure (SBP) (i.e. 15.5 min in MVPA & 9 mmHg in SBP) (80% power, adjusted p-value of 0.025, n= 86 patients/group). Semi-structured interviews will determine (i) patient experience (ii) barriers and enablers to participation in exercise and in service implementation, and (iii) ways to build and maintain referral partnerships. Health utilisation costs will be calculated using NSW Health Activity Based Funding Portal and a tailored Client Services Receipt Inventory.

Results: The pilot program (24 patients) resulted in a significant reduction in SBP (14.6 ± 10.2 mmHg, p<0.001); increased participation in exercise beyond the program; and high patient satisfaction. Data collection for the S+SLAM-TIA trial is ongoing.

Discussion: Piloting and subsequent evaluation of a new program informed a clinical trial which will measure the value at a patient and service level of implementation of an evidence based secondary stroke prevention program.

Biography: To be confirmed

NAHC Conferences

2007, Hobart (7th NAHC)

2009, Canberra (8th NAHC)

2012, Canberra (9th NAHC)

2013, Brisbane (10th NAHC)

2015, Melbourne (11th NAHC)

2017, Sydney (12th NAHC)

2019, Brisbane (13th NAHC)

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