This research project is in progress. PCORI will post its findings here within 90 days after our final review is complete. In the meantime, results have been published in peer-reviewed journals, as listed below.
What is the research about?
Strokes occur when blood vessels to the brain become clogged, cutting off blood flow. Approximately 800,000 people in the United States have a stroke each year. One in four people will have another stroke in the future. Stroke is the fourth leading cause of death and is a leading cause of disability in the United States. Many treatments can help patients as they recover from a stroke. Some treatments can help people avoid having another stroke. But doctors don’t know the benefits and harms for all of the available treatments that may be prescribed for people after they’ve had a stroke, especially for patients who are ages 65 or older and for women and minority patients.
The PROSPER (Patient-Centered Research into Outcomes Stroke Patients Prefer and Effectiveness Research) project includes multiple research studies designed to answer questions that can help patients, doctors, and other healthcare professionals make informed decisions about what types of treatment will help patients after a stroke.
Stroke survivors and researchers are working together to identify different categories of treatment to study. Each is a common type of treatment after stroke. Doctors don’t always prescribe these treatments the same way.
- Blood thinners. These medicines reduce the formation of blood clots, which can cause strokes. Older blood thinners require frequent lab tests and a limited diet. Newer blood thinners don’t have these issues, but doctors don’t know how newer and older treatments compare in terms of side effects.
- Cholesterol medicines. These medicines help to reduce the risk of stroke or heart attack, but they can cause side effects, such as muscle aches. Doctors don’t know if cholesterol medicines work the same in older and younger people.
- Depression medicines. Depression is common after a stroke. Many treatments are available for depression. Doctors don’t know whether depression medicines help people live longer or have a better quality of life after stroke.
The research team wants to learn how different treatments work to help patients return to life at home and avoid return trips to the hospital. The research team also wants to find out how often patients taking different treatments have new strokes, depression, or fatigue and how many patients taking different treatments die. The research team is also asking questions about patients’ abilities to do daily tasks and about patients’ quality of life.
Who can this research help?
The results of this research can help stroke survivors and their doctors make decisions about treatment after a stroke.
What is the research team doing?
In this project, the research team is looking at data from the largest national registry of people who have had strokes. This registry is run by the American Heart Association. The team is linking the data from the registry with Medicare claims. They are using this information to compare how well different treatments work. The research team also is using information from interviews with patients who have gone home after having a stroke to learn about the recovery process.
Each topic in the PROSPER project has its own set of research questions:
- How do older and newer blood thinners compare for preventing stroke?
- How do the blood thinners compare in preventing stroke with not taking a blood thinner?
- How do the side effects of different blood thinners compare?
- Does taking medicine to reduce cholesterol change the risk of having a heart attack or stroke? Does the medicine increase time at home for patients?
- Do the benefits of taking cholesterol medicine change at higher or lower doses?
- What are the potential benefits and harms of different medicines to treat depression in people who have had a stroke?
Research methods at a glance
|Study Design||Observational: cohort study|
|Population||Patients who have had an ischemic stroke and were hospitalized|
|2-year follow-up for primary outcomes|
|Article Highlight: This study compared outcomes of older adults who have atrial fibrillation and have had a stroke. In a new paper published in JAMA Neurology, the research team reports that patients who were prescribed direct oral anticoagulants when discharged from the hospital following a stroke had relatively better outcomes—including more days at home and fewer adverse events—than patients prescribed the blood thinner warfarin. This reinforces findings from prior research on the subject.|
Results of This Project
JAMA Neurology Author Interviews
In an interview as part of the journal's "Author Interviews" series, Adrian F. Hernandez, MD, MHS, discusses what prompted him to launch the study, and what’s new and additive about this study. He notes that it’s one of the largest studies with its focus, and that it enrolled many older patients who have not traditionally been enrolled in studies with this focus.
Finding the Keys to a Longer, Better Life after Stroke
A feature story on this project that looks at how patients who have a stroke often receive medications to prevent a recurrence. Researchers are using medical records and new patient-reported data to examine the benefits and risks of these treatments.
PROSPER Study for Stroke Survivors and Their Families
Adrian F. Hernandez, MD, MHS, associate director at the Duke Clinical Research Institute and Principal Investigator for PROSPER (Patient-Centered Research into Outcomes Stroke Patients Prefer and Effectiveness Research) talks about the study and its impact on the stroke survivor community.
Applying Evidence from the PCORI PROSPER Studies in Stroke Prevention & Care
This Continuing Medical Education/Continuing Education video activity is designed to support healthcare professionals, patients and caregivers, and other stakeholders in applying key findings from the PCORI-funded PROSPER studies to improve outcomes for patients with atrial fibrillation and stroke risk.