The study was conducted at 31 stroke centers across the country.
Stroke is one of the leading causes of death and disability in India. After a stroke, about 15 to 20 percent of patients develop a second stroke (recur). Discontinuation of medicines, uncontrolled blood pressure, blood sugar, continuous smoking, alcohol consumption and following unhealthy food habits are the main reasons for recurrence.
There are two types of stroke – ischemic, when there is a blockage in one of the arteries of the brain; and cerebral hemorrhage, when one of the arteries supplying blood to the brain ruptures and leaks. High blood pressure is the number one cause of ischemic and hemorrhagic strokes.
The trial was conducted by SPRINT-India (Secondary Prevention by Structured Semi-Interactive Stroke Prevention Package) under the Indian Stroke Clinical Trials Network (INSTRuCT) of ICMR in stroke preparedness centers in India, which is the first and first of its kind in developing countries. 4th Government- supported worldwide network.
Health interventions to prevent secondary stroke
The trial’s intervention was a package composed of SMS text messages, health education videos and a stroke prevention workbook for patients. The messages focused on control of blood sugar, blood pressure, cholesterol, improving physical activity, healthy eating, and not missing medication to prevent stroke. The awareness material was systematically developed in 12 different regional languages.
Patients in the control group received standard care while those in the intervention group received awareness at weekly intervals to promote healthy living and adherence to medications.
A total of 4,298 patients were randomly allocated to the intervention arm (2,148) and the control arm (2,150). 1,502 patients in the intervention arm and 1,536 patients in the control arm completed one year of follow-up. The SPRINT India trial used complex behavioral interventions to reduce the recurrence of stroke. Trial results showed that the structured semi-interactive stroke prevention package improved behavioral factors of lifestyle and medication adherence, which may have long-term benefits.
The trial went a step further than contemporary trials in assessing effects on endpoints such as recurrence of cardiovascular events and deaths. However, the follow-up period was too short to show any difference between the control and intervention groups. test results were published in Lancet Global Health magazine.
Dr Jairaj D. Pandian, Professor and Principal of Neurology, Christian Medical College, Ludhiana and Principal Investigator of the Clinical Coordination Centre, said the intervention improved the proportion of patients who quit smoking (83 per cent) and alcohol (85 per cent) group compared to the control group (78 percent and 75 percent, respectively).
Adherence to medications was also better in the intervention arm (94%) than in the control arm (89%). The incidence of stroke, heart attack and death did not differ between the two groups at one year (5.5% vs 4.9%) . follow-up. This may be because the follow-up period was too short or the study centers were stroke-ready centers that were already providing good quality care to stroke patients.”
“The SPRINT study is the first trial in India (and probably globally) that seeks to assess the role of health interventions in secondary prevention of stroke on such a large scale. It is a resourceful combination of lifestyle and therapy leveraging technology Provides hope for improvement in complexities-constrained setup.
In Phase 2 which begins in September 2022, four more stroke trials, which are very relevant to the country, have been initiated by ICMR. We will get answers to important treatments for stroke in the years to come,” said Dr. Meenakshi Sharma Scientist-G, Division of Non-Communicable Diseases, ICMR.