The Video-based Intervention to Reduce Hypertension Treatment and OUtcome Differences in Adults Living with Stroke or Transient Ischemic Attack (VIRTUAL)

Hypertension is the most important risk factor for ischemic and hemorrhagic stroke, and reduction in blood pressure (BP) after stroke is associated with reduced risk of stroke recurrence1-4. However, for the majority of stroke survivors (SS), hypertension remains poorly controlled early after an incident stroke.5-7 In the United States, Black and Hispanic SS are more likely to have poorly controlled risk factors after stroke compared to White SS, and Black and Hispanic SS have higher rates of stroke recurrence compared to White SS.5-11 Prior efforts to reduce differences in BP control among Black, Hispanic, and non-Hispanic White SS have been uniformly unsuccessful.12 Multicomponent care models that include multidisciplinary approaches show promise for improving risk factor control after stroke.13, 14 Differences in access to care after stroke, health literacy, and social support may help to explain racial differences in BP control and stroke recurrence, therefore multidisciplinary post-stroke care models that target these factors may be key to decreasing differences in BP control between Black, Hispanic, and White SS.5, 7, 15 Limited access to post-stroke outpatient care contributes to challenges in developing interventions for post-stroke BP control. Telemedicine and telemonitoring may be ideal approaches for improving access to care in SS. The COVID-19 pandemic has led to rapid expansion of telemedicine for post-acute care in stroke survivors; however, its effectiveness is unproven. Based on preliminary data at our center, we propose a randomized trial testing an integrated multidisciplinary telehealth intervention, the Video-based Intervention to Reduce Hypertension Treatment and OUtcome Differences in Adults Living with Stroke or Transient Ischemic Attack (VIRTUAL), in SS recently discharged home after inpatient hospitalization for ischemic stroke, hemorrhagic stroke, or transient ischemic attack. The intervention will include post-discharge telehealth visits by a multidisciplinary team, risk assessments to address patient specific needs, and home BP telemonitoring and management. The care team includes neurology providers (physician and nurse practitioner), a pharmacist, and a social worker. Standard care will include follow-up with a neurologist and primary care provider and pharmacist-assisted BP adjustment. We aim to assess 1) the impact of the intervention on BP control 6 months following stroke assessed with ambulatory BP monitoring; 2) the impact of the intervention on recurrent vascular events 1 year after stroke; 3) the impact of the intervention on health services access and utilization following stroke; 4) moderating effects by Black and Hispanic group on the relationship between the intervention and BP control, vascular events, and health services utilization; 5) the relationship between patient-specific factors such as healthcare access, health literacy, and social support on primary and secondary outcomes.