Authors: (including presenting author): :
Mok YNM(1), Chan YS(1), Chui KS(1), Ho PC(1), Duong KH(1), Cheng S(1), Li R(1), Cheung CM(1), Au Yeung M(1)
Affiliation: :
(1) Department of Medicine, Pamela Youde Nethersole Eastern Hospital
Keyword 1: :
Post-stroke Blood Pressure Management
Keyword 2: :
Post-discharge 28-days
Keyword 3: :
Hypertension-related Unplanned Readmission
Keyword 4: :
Pre-discharge education
Keyword 5: :
Nurse-led clinic
Introduction: :
Hypertension is a key modifiable risk factor for recurrent stroke. Blood pressure (BP) elevation and fluctuation are common immediately following a stroke; but intensive BP lowering will cause adverse outcomes, including mortality. Therefore, non-intensive BP control achieved through acute stroke treatment, recurrent stroke prevention and cognitive impairment or dementia prevention are crucial to without prior cardiovascular-disease stroke survivors. In fact, post-stroke BP fluctuation after discharge is very common for unplanned readmission (UR) to seek for medical treatment. In addition to long wait for post-stroke Hospital Authority or Government medical follow-up, we need to seek strategies or alternatives for post-stroke uncontrolled home BP support before scheduled follow-up.
Objectives: :
To evaluate post-stroke blood-pressure management (PSBPM) strategies in reducing hypertension-related unplanned readmission (UR)
Methodology: :
From 2020 onwards, a series of PSBPM strategies were implemented, including: i) home BP guide-record book endorsed by Neurology Team in 2020; ii) pre-discharge education on diet control, exercise, drug compliance, home BP monitoring- record-management to all home-discharge strokes with hypertension; iii) nurse-led clinic (NC) as gatekeeper to notify Neurology Team for anti-hypertensive drug adjustment in uncontrolled BP within 28 days discharge since 2021. A cohort retrospective study was conducted to review hypertension-related UR between 2018 and 2024. All data was collected prospectively using “Microsoft Excel” for analysis.
Result & Outcome: :
Comparison between 2018 to 2024, annual acute stroke admissions ranged from 902 to 1035; directly home-discharge were 316 to 380 with 65.8% to 73.7% with hypertension risk factor respectively. 100% acute strokes with hypertension received education on home BP monitoring-management before home-discharge. Annual referrals with hypertension to ambulatory stroke NC were from 129 to 174. After implementation of PSBPM strategies, annual Neurology Team consultations by stroke NC for uncontrolled BP support were increased from 3 to 16 (433.3% increase). Unplanned readmissions with hypertension and other complications were reduced from 15 to 8 (46.7% decrease). In conclusion, Pre-discharge education emphasizing importance of home BP monitoring-and-management; with alternative stroke NC follow-up can provide significant support in patient safety and minimize post-discharge 28-days unplanned readmission to post-stroke uncontrolled BP without other complications.
