Post Discharge Needs of Mild Stroke and TIA Patients: The DESERVE Trial

Despite significant risk of recurrence, mild stroke/TIA patients have short hospital stays, quick discharge, and often leave with inaccurate perceptions of future vascular risk. There is very little understanding of patient identified needs post-discharge. DESERVE is an innovative patient-paced, behavioral discharge intervention aimed at secondary stroke prevention through skill acquisition focused on patient-physician communication, medication adherence, and risk perception in a multi-ethnic mild stroke/TIA cohort. Using discharge as the “teachable moment” and foundation for behavioral change, DESERVE evaluates a culturally-tailored patient engaged approach. Intervention includes: motivational stroke survivor narrative video imbedded with strategies for risk reduction and recovery, a patient-paced interactive workbook,  72 hr post discharge phone call focusing on physician communication with later follow-up calls promoting integration into community resources. To date, 146 patients have been enrolled; mean age 65 yrs; 48% male; 34% Hispanic, 41% black; and 29% < HS education. Vascular risk burden is high with 82% hypertensive, 45% diabetic, and 48% with metabolic syndrome.  Among participants randomized to intervention and followed up at 72 hours (n=63), 76% asked for patient-physician communication strategies; 49% needed help scheduling a follow-up neurology appointment; and 73% percent had issues understanding discharge medication/instructions. While a primary focus of recovery for mild stroke/TIA should be successful control of modifiable risk factors, quick discharge may leave patients confused about long-term prevention goals. An interactive culturally-tailored intervention at discharge focused on accurate risk perception, medication adherence and patient-physician communication may be linked to improved risk factor control and secondary stroke prevention.