Life After STroke. A Norwegian long-term follow-up project (LAST-long)

We have robust evidence on how to approach acute and subacute care after stroke. Unfortunately, this does not account for the long-term management. The main objective of the LAST-long study (Life After Stroke. A Norwegian long-term project) is to meet this challenge by establishing an evidence-based, cost-effective, multimodal approach to long-term follow-up, in order to prevent functional and cognitive decline, recurrent cerebrovascular events and to reduce the burden of stroke to the patients, their families and to the health care system. To achieve this goal, we have organized the project in different sub-studies. Firstly, trajectory analyses will be applied on data from two cohorts (Nor-COAST and Midnor-STROKE) including 1300 participants who are followed for three years after stroke. The analyses will identify and describe different trajectories of physical function, cognition and the need for healthcare services over three years after stroke. Both modifiable and non-modifiable characteristics of the participants who follow these trajectories will be identified. The 3-year follow-up has been completed and we are now working on the initial analysis. Furthermore, the benefit of the pathway of stroke care (introduced by the Ministry of Health in 2018) is being evaluated in a PhD project, by comparing data from the Norwegian stroke registry from 2017 with data from 2019. In the first paper published in International Journal of Stroke by PhD student Elin Bergh and colleagues in October 2022, we found no difference in functional outcome from before to after implementation of the pathway. Paper 2, which is under review by International Journal of Stroke and Cerebrovascular Disease, is investigating the association between goal attainment during the pathway of stroke care and quality-og-life 3 months later. The analyses for paper 3 are going on and we expect the results to be published by the spring 2024. The most extensive part of LAST-long is the randomized controlled trial aiming to investigate the effect of regular follow-up by a community-based stroke-coordinator who sets up a treatment plan targeting the individual needs to prevent cognitive and functional decline in the long term after stroke. The cost-effectiveness of the intervention will also be evaluated. A total of 301 eligible individuals with stroke admitted to the stroke units at St. Olavs hospital, Akershus University Hospital, Bærum hospital and Ålesund hospital have been included and randomized, either to follow-up by the stroke-coordinator or to standard care with regular follow-up from their general practitioner and the primary health care system. All included participants undertake a blinded assessment 6, 12 and 18 months after inclusion. Recruitment was concluded by February 2023.LAST-long was presented as an ongoing trail at the European Stroke Organization Conference in Munich, Germany, May 2023. The protocol paper was published by BMJ Open at the same time. LAST-long commenced by October 2018 and will be completed within September 2024.

Yearly about 12 000 Norwegians suffer from stroke, and the number of stroke survivors is increasing. The Norwegian guidelines recommend acute treatment in a stroke unit and further follow up by an early supported discharge service. The guidelines are vaguer on the recommendations for the long-term follow up, leaving a gap in the evidence for treatment to maintain optimal function in the long term. The evidence for non-pharmacological secondary prevention in order to prevent functional decline and stroke recurrence is also sparse. Hence, there is a need for research aiming to improve clinical practice for long-term follow-up after stroke. The overall aim of the LAST-long project is to establish an evidence based, cost effective, multimodal approach to long-term follow up after stroke, in order to prevent functional decline, cognitive decline, recurrent cerebrovascular events and to reduce the burden of stroke to the patients, their families and to the health care system. Six work packages (WPs) will be established to achieve the aim of the project. The main objectives are: WP1: To adequately manage and control the project and to ensure timely achievement of the overall objectives, milestones, and deliverables at the highest possible quality. WP2: To identify distinct trajectories for function in the long term after stroke. WP3: To evaluate how the introduction of the standardized pathway of stroke care is related to outcome after stroke. WP4: To investigate the benefit of regular follow-up by a health-coordinator who promotes an individualized multimodal treatment to prevent functional decline in the long term. WP5: To investigate how costs varies during the pathway of stroke, in a long-term perspective, and to investigate whether new stroke interventions are cost-effective. WP6: To develop a dissemination and implementation strategy for the project results focusing on dissemination to the scientific community, stakeholders, public community and end users.