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Publications

Journal Article Systematic Review Meta-Analysis Ppublish

PubMed: 39854272 DOI: 10.1093/qjmed/hcaf029

Integrated care management for patients following acute stroke: a systematic review.

QJM 118(5):317-328

Authors: Ian Eustace, Benjamin J R Buckley, Isik Kaya, Katie L Hoad, Madeleine France-Ratcliffe, Andrew M Hill, Gregory Y H Lip, Ian D Jones, Karen Higginbotham

Affiliations

  • School of Nursing and Advanced Practice, Liverpool John Moores University, Liverpool, UK. Liverpool Centre for Cardiovascular Science, University of Liverpool, Liverpool John Moores University and Liverpool Heart and Chest Hospital, Liverpool, UK.
  • Liverpool Centre for Cardiovascular Science, University of Liverpool, Liverpool John Moores University and Liverpool Heart and Chest Hospital, Liverpool, UK.
  • Cardiovascular Health Sciences, Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UK.
  • West Hertfordshire Teaching Hospitals NHS Trust, Watford, UK.
  • Mersey and West Lancashire Teaching Hospitals NHS Trust, Liverpool, UK.
  • Danish Center for Health Services Research, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.
  • School of Nursing and Advanced Practice, Liverpool John Moores University, Liverpool, UK.

Abstract

Contemporary stroke care is moving towards more holistic and patient-centred integrated approaches, however, there is need to develop high quality evidence for interventions that benefit patients as part of this approach. This study aims to identify the types of integrated care management strategies that exist for people with stroke, to determine whether stroke management pathways impact patient outcomes and to identify elements of integrated stroke care that were effective at improving outcomes. The study is a systematic review with meta-analysis. The review was conducted using Medline, CINAHL, Web of Science and the Cochrane Database of randomized controlled trials from January 2012 to January 2024. Studies that evaluated interventions as part of integrated care against a control or standard treatment group were included. Primary outcomes included mortality, recurrent stroke and major bleeding. Secondary outcomes included quality of life, unplanned readmission, anxiety and depression, lifestyle and cardiovascular risk factors, and adherence to intervention. In total, 99 studies were included and 63 were meta-analysed. Patients receiving integrated stroke care had significant reductions in recurrent stroke (RR 0.79, 95% CI: 0.63-1.00, P = 0.05, I2 = 39%), significant improvements in quality of life (SMD = 0.41, 95% CI: 0.26-0.56, P < 0.00001, I2 = 91%) and reduced incidence of depression (RR 0.95, 95% CI: 0.92-0.99, P = 0.007, I2 = 22%). There were no significant differences in mortality or major bleeding. The findings of this study show that integrated care post-stroke is associated with better quality of life and reduced depression and recurrent stroke.

MeSH

Depression, Quality Of Life, Mortality, Hemorrhage, Stroke, Clinical Medicine