Promoting Self-Management in Stroke Survivors Using Health Information Technology

Stroke survivors have a strong risk of recurrent stroke, heart attack, and heart failure due to the high prevalence of comorbid hypertension (HTN), diabetes, and elevated cholesterol. Post-discharge, stroke care is fragmented and inconsistent. Survivors tend to have poor risk factor management and medication adherence, leading to the risk of recurrence. Interventions to improve HTN control and medication compliance can prevent hospital readmissions and ultimately decrease costs of medical care.

The goal of this study was to test usability, feasibility, and efficacy of the American Heart Association’s Heart360, a mobile health technology (mHealth) tool used to facilitate HTN self-management among stroke survivors. Heart360 serves as a personal health record (PHR): when patients receive text message reminders their response is uploaded to it as health data. The researchers used Heart360 to evaluate self-management tasks and medication therapy management for HTN control among stroke survivors.

The specific aims of the project were as follows:

• Examine Heart360 usability by stroke survivors or their caregivers for self-management tasks, including daily blood pressure (BP) monitoring, communication with providers, and medication management. 
• Characterize rates of HTN control into guideline recommended ranges at 3 months after enrollment in the Heart360 group versus the usual care group. 
• Examine rates of adherence to antihypertensive medications at 3 months after enrollment in the intervention versus control groups. 

In this randomized controlled trial, stroke survivors in the intervention group measured their BP and uploaded data into the Heart360 health management tool via text message. Study investigators sent the intervention group recommended medication adjustments based on their 7-day BP averages. Control subjects received usual care consisting of a home BP monitor and an American Stroke Association booklet on HTN and stroke. Study outcomes indicated good usability and feasibility of Heart360 for HTN management after stroke. Intervention participants showed significant improvement in HTN control compared to the usual care control group. Researchers recommend future studies to evaluate the effectiveness of this technology on a larger scale in populations, including both stroke survivors and those at high risk of stroke and cardiovascular events.