LAUSR

The global burden of stroke is huge, with 10.3 million new strokes and 116 million disability-adjusted life years per year. People who had a stroke are at higher risk to experience a second event. In most cases, a second stroke is likely to be more severe than the previous one, increasing even more the probability of death or disability. According to the Global Burden of Disease 2013 study, potentially modifiable risk factors cause >90% of the stroke burden. Considerable efforts have been made in the development of new drugs for secondary prevention. However, there is a remarkable shortage of measures on the implementation of therapies and preventive strategies that have already been proved to be effective. Improved cardiovascular outcomes depend largely on how well affected people manage these conditions amid face-to-face office visits with their healthcare providers. The complexity of a patient’s medication regime, the importance of self-monitoring for signs of emerging complications, and the need for lifestyle behavior changes, including physical activity, healthy diet, smoking cessation, and weight loss often make self-management an overwhelming challenge. Secondary prevention strategies have been reported to result in a dramatic reduction in the risk of stroke recurrence, vascular events, or death. Several studies indicate that a theoretical complete control of all modifiable risk factors would reduce up to 75% the incidence of stroke recurrence. Nevertheless, the facts point that the level of control and correction of these risk factors are far from being at this ideal stage. The adherence to secondary preventive medications after a stroke is known to be inconstant, and poor compliance is related to adverse outcomes. In some studies, more than half of participants stopped taking their prescribed drugs in 1 to 2 years after the incident stroke. Background and Purpose—Risk factor control and treatment compliance in the following months after stroke are poor. We aim to validate a digital platform for smartphones to raise awareness among patients about the need to adopt healthy lifestyle, improve communication with medical staff, and treatment compliance. Methods—Farmalarm is an application (app) for smartphones designed to increase stroke awareness by medication alerts and compliance control, chat communication with medical staff, didactic video files, exercise monitoring. Patients with stroke discharged home were screened for participation and divided into groups: to follow the FARMALARM program for 3 to 4 weeks or standard of care follow-up. We determined achievement of risk factor control goals at 90 days. Results—From August 2015 to December 2016, from the 457 patients discharged home, 159 (34.8%) were included: Farmalarm (n=107); age 57±12, Control (n=52), age 59±10; without significant differences in baseline characteristics between groups. At 90 days, knowledge of vascular risk factors was higher in FARMALARM group (86.0% versus 69.2%, P<0.01). The rate of patients with diabetes mellitus (83.2% versus 63.5%, P<0.01) and hypercholesterolemia (80.3% versus 63.5%, P=0.03) under control and the rate of patients with 4 out of 4 risk factors under control was higher in FARMALARM group (50.4% versus 30.7%, P=0.02). A regression model showed that the use of Farmalarm was independently associated with all risk factors under control at 90 days (odds ratio, 2.3; 95% CI, 1.14–4.6; P=0.02). Conclusions—In patients with stroke discharged home, the use of mobile apps to monitor medication compliance and increase stroke awareness is feasible and seems to improve the control of vascular risk factors. (Stroke. 2019;50:18191824. DOI: 10.1161/STROKEAHA.118.024355.)