Empowerment and Mobile Technology in the Control of Cardiovascular Risk Factors in Patients With Ischemic Stroke

Atrial fibrillation (AF) and hypertension are among the main treatable risk factors for ischemic stroke and transient ischemic attack (TIA). Detecting paroxysmal atrial fibrillation in stroke patients is challenging, but highly relevant since anticoagulation can effectively reduce the risk of recurrent strokes. Furthermore, hypertension remains poorly controlled even after stroke despite multiple available treatment options. In the CARDIOSTROKE trial, the investigators aim to randomize 405 patients with recent ischemic stroke or TIA into (1) standard diagnostic work-up, follow-up and treatment (control group) and (2) 3-week ECG monitoring to detect occult AF and self-monitoring of blood pressure with mobile-device-assisted self-titration of antihypertensive medication (intervention group). Randomization will occur 2:1 into control and intervention groups. The co-primary outcomes include (1) incidence of new-onset AF and (2) difference in the mean blood pressure at 12-months.

Inclusion criteria

• Ischemic stroke or transient ischemic attack (ABCD2 score ≥3)
• Age ≥40 years
• Pre-existing or newly diagnosed hypertension
• Informed consent from the patient or legal representative

Exclusion criteria

• Known high-risk source of cardioembolism
• Known indication for anticoagulation
• Contraindication for anticoagulation
• Pacemaker
• Non-compliance to study interventions as judged by the investigator
• Serious condition hampering the study conduct