Reduced Poststroke Complications after Combination of Multidimensional Nursing Interventions and Antiplatelet Therapy

Summary

This retrospective single-center study investigates whether structured post-discharge nursing follow-up reduces short-term complications in ischemic stroke patients receiving antiplatelet therapy, reporting fewer 30 day complications and improved complication-free survival.

Abstract

Stroke survivors remain at high risk of recurrent events and complications despite standard antiplatelet therapy. Multidimensional nursing interventions may improve outcomes by addressing the medical, functional, and psychosocial needs that conventional care often overlooks during the recovery period. This retrospective, single-center study included 120 ischemic stroke patients discharged on antiplatelet therapy. Patients were divided into an intervention group receiving multidimensional nursing care and a control group receiving conventional care. The primary outcome was the incidence of post-stroke complications within 30 days of discharge. The secondary outcome was complication-free survival over 12 months of follow-up. Logistic regression was used to assess the intervention effect on the primary outcome, and Kaplan–Meier survival analysis was used to evaluate the secondary outcome.

For the primary 30-day outcome, the incidence of complications was significantly lower in the intervention group (11.7% vs. 35.0%, P < 0.01). Multivariable logistic regression, adjusting for age, stroke severity (NIHSS score), and BMI, identified the nursing intervention as an independent protective factor against 30-day complications (adjusted odds ratio [AOR] = 0.267, 95% CI: 0.108–0.658, P = 0.005). For the secondary 12-month outcome, Kaplan–Meier analysis demonstrated significantly prolonged complication-free survival in the intervention group compared with the control group (log-rank P = 0.0042).

These findings suggest that a multidimensional nursing intervention combined with standard antiplatelet therapy may reduce the incidence and delay the onset of post-stroke complications in patients with ischemic stroke. However, due to the retrospective, non-randomized design and potential residual confounding, these findings should be considered hypothesis-generating and confirmed in prospective randomized trials.

Introduction

Stroke remains a formidable global health challenge, persisting as the second leading cause of death and a major contributor to long-term adult disability worldwide¹. For the millions who survive, the journey to recovery is fraught with significant hurdles. The standard of care for secondary prevention in ischemic stroke patients is long-term antiplatelet therapy. However, despite this pharmacological intervention, the risk of recurrent vascular events and medical complications remains substantial, with approximately 10–11% of survivors experiencing another stroke within the first year². Beyond recurrence, survivor....

Protocol

Study design and participants
This retrospective, single-center observational study was approved by the Ethics Committee of Hunan Brain Hospital (approval number: HBH-2021-045; date of approval: March 15, 2021). Given the retrospective nature of the research, the requirement for informed consent was waived. The study was conducted in the stroke unit of a tertiary hospital in Changsha, China, between January 2021 and December 2023. The reporting of this study follows the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines.

Eligibility criteria
Patient....

Results

Participant flow and baseline characteristics
A total of 312 patients with ischemic stroke were screened for eligibility during the study period. Of these, 192 patients were excluded for the following reasons: hemorrhagic stroke or transformation (n = 48), terminal illness with life expectancy <12 months (n = 23), severe cognitive impairment (n = 31), participation in other disease management programs (n = 17), residence outside the catchment area (n = 42), and incomplete medical records (n = 31)........

Discussion

This retrospective analysis found that a multidimensional nursing intervention, when added to standard antiplatelet therapy, was associated with improved outcomes for post-stroke patients. For the primary 30-day outcome, patients who received comprehensive nursing care had a significantly lower incidence of early complications compared to those receiving conventional care (11.7% vs. 35.0%, P = 0.005). After adjusting for age, stroke severity, and BMI in multivariable logistic regression, the intervention remained indepen.......

Materials

List of materials used in this article

Name	Company	Catalog Number	Comments
Aspirin	Bayer AG	N/A	Antiplatelet medication, 100 mg tablets
Clopidogrel	Sanofi	N/A	Antiplatelet medication, 75 mg tablets
Electronic medical record system	Winning Health Technology Group	N/A	Hospital information system used for data extraction
Hospital Anxiety and Depression Scale (HADS)	Mapi Research Trust	N/A	Psychometric instrument for screening emotional distress
Montreal Cognitive Assessment (MoCA)	MoCA Clinic	N/A	Cognitive screening tool, version 8.1
National Institutes of Health Stroke Scale (NIHSS)	National Institutes of Health	N/A	Standardized neurological examination for stroke severity
R package: ggplot2	R Foundation	N/A	Data visualization package, version 3.4.2
R package: survival	R Foundation	N/A	Survival analysis package, version 3.5-5
R package: tableone	R Foundation	N/A	Baseline table generation package, version 0.13.2
R software	R Foundation for Statistical Computing	N/A	Statistical analysis software, version 4.3.0
Water swallow test	N/A	N/A	Bedside screening tool for dysphagia
Zenodo	CERN	N/A	General-purpose data repository, DOI: 10.5281/zenodo.10839456