Oral Presentation Australian and New Zealand Stroke Organisation Conference 2025

Factors associated with the selection and attainment of secondary prevention goals after stroke in the ReCAPS trial (123250)

Liam P Allan 1 2 , Muideen T Olaiya 1 , Jan Cameron 1 3 , Monique F Kilkenny 1 4 , Nadine E Andrew 5 6 , Natasha A Lannin 7 8 , Amanda Thrift 1 , Vincent Thijs 9 , Maree Hackett 10 , Ian Kneebone 11 , Dominique Cadilhac 1 4
  1. Department of Medicine, School of Clinical Sciences, Monash University, Clayton, Victoria, Australia
  2. Australian e-Health Research Centre, Commonwealth Scientific and Industrial Research Organisation, Brisbane, Queensland, Australia
  3. Australian Centre for Heart Health, Royal Melbourne Hospital, Melbourne, Victoria, Australia
  4. Stroke Theme, Florey Institute of Neuroscience and Mental Health, University of Melbourne, Parkville, Victoria, Australia
  5. Peninsula Clinical School, School of Translational Medicine, Monash University, Clayton, VIC, Australia
  6. National Centre for Healthy Ageing, Monash University, Frankston, VIC, Australia
  7. Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia
  8. Alfred Health, Melbourne, Victoria, Australia
  9. Department of Medicine, Austin health, Melbourne, VIC, Australia
  10. The George Institute for Global Health, Department of Medicine, University of New South Wales, Bangaroo, NSW, Australia
  11. Graduate School of Health, Faculty of Health, University of Technology Sydney, Chippendale, NSW, Australia

Background: Lifestyle changes after stroke can prevent recurrence, but are difficult to enact. A broadly focussed self-management intervention, combining goal setting and electronic messages, was evaluated in the Recovery-focused Community support to Avoid readmissions and improve Participation after Stroke (ReCAPS) trial.

Aim: To describe various factors associated with secondary prevention goal setting and attainment at 90 days post-randomisation.

Methods: Sub-study of a phase III randomised controlled trial. Eligibility: confirmed stroke, ≥18 years old, discharged home within 10-14 days, and mRS 0-4. Intervention: 12-weeks of goal-aligned and administrative messages; control: administrative messages only. Generalised linear models were used to determine the factors associated with the number and types of secondary prevention goals selected or attained (measured via Goal Attainment Scaling). 

Results: Among 465 randomised participants, 390 (84%, median 67 years, 33% female) set at least one secondary prevention goal, mostly for increasing physical activity (27%) and controlling blood pressure (17%). Participants with prior stroke selected more prevention goals (incident rate ratio [IRR] 1.33, 95% CI 1.03–1.73, p=0.030), while older age was associated with selecting fewer goals (IRR=0.92, 95% CI 0.86–0.98, p=0.017). The intervention was associated with greater overall secondary prevention goal attainment (IRR=1.30, 95% CI 1.06–1.61, p=0.014).  History of depression (IRR=0.62, 95% CI 1.12–1.76, p=0.003) and older age (IRR=0.89, 95% CI 0.82–0.97, p=0.008) were was associated with attaining fewer goals.

Conclusion: Goal setting for secondary prevention was feasible, and attainment may be enhanced by tailored electronic message support. Patient-level factors which impact attainment must be considered.