Integrated care management for patients following acute stroke: a systematic review

Contemporary stroke care is moving towards more holistic and patient-centred integrated approaches, however, there is need to develop high quality evidence for interventions that benefit patients as part of this approach. This study aims to identify the types of integrated care management strategies that exist for people with stroke, to determine whether stroke management pathways impact patient outcomes and to identify elements of integrated stroke care that were effective at improving outcomes. The study is a systematic review with meta-analysis. The review was conducted using Medline, CINAHL, Web of Science and the Cochrane Database of randomized controlled trials from January 2012 to January 2024. Studies that evaluated interventions as part of integrated care against a control or standard treatment group were included. Primary outcomes included mortality, recurrent stroke and major bleeding. Secondary outcomes included quality of life, unplanned readmission, anxiety and depression, lifestyle and cardiovascular risk factors, and adherence to intervention. In total, 99 studies were included and 63 were meta-analysed. Patients receiving integrated stroke care had significant reductions in recurrent stroke (RR 0.79, 95% CI: 0.63-1.00, P = 0.05, I2 = 39%), significant improvements in quality of life (SMD = 0.41, 95% CI: 0.26-0.56, P < 0.00001, I2 = 91%) and reduced incidence of depression (RR 0.95, 95% CI: 0.92-0.99, P = 0.007, I2 = 22%). There were no significant differences in mortality or major bleeding. The findings of this study show that integrated care post-stroke is associated with better quality of life and reduced depression and recurrent stroke.