Hernandez discusses PROSPER at Research Conference

February 7, 2014 – Adrian Hernandez, MD, outlined the aims and methods of the Patient-Centered Research into Outcomes Stroke Patients Prefer and Effectiveness Research study.

The DCRI’s Adrian Hernandez, MD, discussed the Patient-Centered Research into Outcomes Stroke Patients Prefer and Effectiveness Research (PROSPER) study at Tuesday’s Research Conference at North Pavilion.

Strokes are the fourth-leading cause of death in the United States, killing almost 130,000 Americans each year. More than 795,000 Americans experience a stroke each year; almost one in four of these people have suffered a previous stroke. The Centers for Disease Control and Prevention estimate that strokes cost the nation approximately $38.5 billion annually. Treatment for stroke patients often includes anticoagulants, statins, and antidepressants. However, Hernandez said, there is little quality research on the effectiveness of these treatments, particularly among women, minorities, and the elderly.

Adrian HernandezTo produce this kind of research, the Patient-Centered Outcomes Research Institute (PCORI) was established. In September 2013, PCORI awarded Hernandez a $2 million grant to launch PROSPER. The study, he said, was designed “to make sure we get the best bang for our buck in terms of value of care for the choices that we have.”
PROSPER will compare the effectiveness and safety of warfarin, a common anticoagulant, versus no treatment and versus treatment with newer anticoagulants. It will include a similar comparison of cholesterol medications, as well as evaluate the effectiveness of antidepressants in stroke patients. The primary outcome measurement will be the number of days that patients are alive and feeling well after being discharged from the hospital.

The rationale for the study arose from conversations with stroke survivors, which revealed two dominant themes: concern over the safety and effectiveness of long-term medication, and how long-term medication affects quality of life and daily activities. These concerns dictated the major aims of the study, which are to develop a national platform to identify the outcomes most favored by patients; to apply this platform to comparative-effectiveness research on these outcomes; and to design, evaluate, and implement decision tools from this research to empower stroke survivors to make more informed treatment choices.

To do so, Hernandez said, PROSPER is using existing data sources and infrastructure such as the American Heart Association’s Get With The Guidelines-Stroke registry. It will also utilize focus groups of stroke survivors to better understand patient concerns and questions.

“[PROSPER] is really a new effort for all of us in terms of doing research side-by-side with patients,” he said.