Shared Team Approach between Nurses and Doctors for Improved Risk Factor Management for stroke patients (STAND-FIRM) - A Randomised Controlled Trial

Stroke occurs in about 50,000 Australians each year and has devastating health consequences. Approximately 40% die within 12 months of the stroke, and about 50% of survivors are dependent on others to help them with personal everyday living. In addition, survivors of stroke are at greater risk of further vascular events, these being reported to occur as frequently as 30% within 5 years of a stroke.

Approximately 28% (14,000 of the 50,000) of annual stroke events in Australia are recurrent events, costing about $305 million per year. We can prevent these recurrent strokes from occurring by ensuring that patients are taking appropriate medications that have proven efficacy. Currently, uptake of these therapies is poor. This project is aimed at assessing whether risk factor management after stroke can be successfully improved. We are using a simple approach that maximises participation of General Practitioners, and utilises blinded outcome assessment and intention-to-treat analysis. If the intervention is shown to be cost-effective, this approach can be easily implemented across Australia. The intervention has the potential to improve risk factor management and outcome in stroke as well as many other chronic diseases.

North East Melbourne Stroke Incidence Study (NEMESIS)

Stroke is the second single greatest killer and one of the leading causes of disability in Australian adults. Over 53,000 strokes occur in Australia every year with a stroke occurring every 10 minutes. A stroke occurs when blood supply to a part of the brain becomes blocked or bleeds.

The NEMESIS study is the largest population-based study of stroke conducted in Australia. The team is following the progress of stroke sufferers in Melbourne is providing invaluable data on the long-term effects of stroke in the community. They are doing this by conducting annual follow-ups in their North-East Melbourne Stroke Incidence Study (NEMESIS). Prof Thrift's research has tracked the health of 1686 people - aged from two to 102 - who suffered a stroke between May 1, 1996 and April 30, 1999. Since then, their lives have been tracked on an annual basis and information has been gathered on their ongoing healthcare arrangements and their needs. This project began when Prof Thrift and her team sought information on how many strokes occur in Melbourne and found that here, as in other parts of the country, meaningful data was unavailable. The major aims of this project were to determine the number of strokes occurring, the outcomes and its cost to patients and society.

The following questionnaires were used to assess the patients' health:

  • Cost of stroke - costs associated with extra medical tests, medications, rehabilitation, therapy at home, health service providers and caregivers. The aim was to calculate the ongoing cost of stroke.
  • Physical wellbeing - this assessment provided information about the help patients need in everyday life and how this affects a person's quality of life. This also included assessing management of other medical conditions and the lifestyle factors that might affect patients, for example measurement of BP and questions about smoking, alcohol and medication use.
  • Mental wellbeing - provided information on how stroke may affect the patients' memory or emotional state.

Prof Thrift's research has important implications for the development of health policy over the next decade. More hospital and nursing home beds will be needed if stroke figures are not reduced. A three per cent reduction in stroke incidence is needed per year just to prevent an increase in the number of strokes we have now into the future.

Rishi Valley Study

The Rishi Valley study is a collaborative project between Monash University and the Rishi Valley Rural Health Centre.

Although the most common causes of disease burden in countries such as India include malnutrition and infectious disease, vascular disease is being increasingly recognized as an emerging epidemic. In urban Indian populations, changes in lifestyle exposures (resembling those seen in developed nations) may underlie this phenomenon. However, even less is known about the burden of vascular disease in those living in rural communities.

The main aim of this study is to identify risk factors for hypertension in this rural region where people do not exhibit the traditional risk factors for stroke, i.e. they are young, thn, and physically active. Another aim is to obtain important baseline data on the extent of vascular disease (heart disease and stroke) and its risk factors in this typical rural Indian community.

This survey will provide important and comprehensive data regarding the prevalence of vascular disease risk factors in a rural Indian community. It will be the first major step in planning effective public health interventions to treat or prevent vascular disease in a disadvantaged Indian community.

This survey is being conducted in the Rishi Valley, an area situated in the interior of rural Andhra Pradesh, a major South Indian State. It is home to the villages of a stable rural community of approximately 35,000 residents. The population consists primarily of shepherds and marginal subsistence farmers, with landholdings of less than one acre.

Residents of the villages are being interviewed and tested to obtain information regarding:

  • Lifestyle - diet, activity, smoking, and alcohol
  • BP, height, weight, waist and hip are being measured using standard criteria
  • Blood analysis - finger-prick tests will be done for blood glucose, cholesterol, triglycerides and haemoglobin.

Surveillance and Monitoring Function of the National NCD Programme of Vietnam

Monash University collaborates with the Menzies Research Institute to conduct this study. In developing nations, the burden of CVD, stroke, diabetes, and cancer is taking over from the traditional problems of infectious disease, of maternal and child illness and death, and of disorders due to under-nutrition and deficiency disease.

Cardiovascular mortality, cancer and diabetes top the league tables of mortality in Vietnam, alongside mortality from injury. The burden of the non-communicable disease (NCD) epidemic in Vietnam is accelerating in synchrony with economic development.

This study aims to establish a sustainable system for NCD surveillance in Vietnam. Such NCD will include CVD, stroke, diabetes and cancer as priorities among others.

Over the study period our plan is to implement the following process in order to achieve the main objective:

  1. Develop sustainable infrastructure and systems needed to conduct and implement the surveillance program;
  2. Design and conduct well-targeted surveillance of NCD and risk factors in Vietnam;
  3. Develop systems to monitor clinical care of at-risk groups or individuals;
  4. Develop systems to design and monitor the efficacy of public awareness health campaigns; and
  5. Establish a comprehensive system of accessing and reporting NCD data at national and international levels.