BACKGROUND:Care partners experience multiple psychosocial and physiological stressors while supporting patients with stroke. We aimed to adapt an existing care partner-focused support program for skill building and psychosocial support. We sought to examine the implementation of the support program in an early-supported stroke discharge clinic and investigate the effects of the support program on care partner-reported mental health and burden. METHODS: The study followed a type 2 hybrid implementation-effectiveness design. During the implementation phases, key stakeholders evaluated and adapted the support intervention for the stroke population and completed a prospective evaluation of care partner roles in the target stroke clinic. During the intervention phase, care partners participated in the support intervention per the parent study protocol. Implementation feasibility and acceptability were evaluated, and we evaluated care partner-reported measures of physical and mental health and burden measured at baseline, 12, and 24 weeks. RESULTS : The support program was determined suitable for implementation in the target stroke clinic with a scaling-out implementation strategy. In the target stroke clinic, care partners primarily supported instrumental activities of daily living. Of 17 care partners enrolled in the support intervention, 12 completed baseline assessments. Participants who completed the intervention (n = 8) reported high satisfaction and acceptability of the program components, but some expressed concerns about the length of the surveys. Overall mental health scores increased, and burden decreased in both groups from baseline to 24 weeks. CONCLUSION : The support program adapted for care partners of patients after stroke was acceptable and feasible and has potential for benefit to physical and mental well-being and burden, though this pilot was not powered to detect significance of outcomes for participants. Scaling out may promote efficient use of limited care partner services in a health system.

Patients with stroke often have upper limb impairment that impacts function and quality of life. Increased amounts of arm training in the early phase post stroke may reduce impairment of the arm, but are not achieved in standard therapy. Video Gaming Technology (VGT) has been shown to improve activity, participation, and function, and could be a unique and engaging strategy for training the arm in high doses when delivered during critical periods and within the standard of care. This paper describes a standardized approach to implementing prescribed VGT for patients hospitalized with acute stroke stratified by level of impairment. This is a description of a novel methodology used with adult patients hospitalized with acute stroke and upper extremity impairment in the stroke unit or the acute inpatient rehabilitation facility. The gaming protocol and stratification model utilize strategies for matching patient-specific impairments to an assigned VGT intervention to optimize engagement and accelerate recovery. In addition, a unique 'Stopping Criteria' is described that helps clinicians administer safe game play with acute populations at a goal dose of up to 60 min of time on task (TOT) arm movement. Response is measured to track safe completion of the protocol and response to treatment, including outcomes like change in Upper Extremity Fugl-Meyer (FMUE) from baseline to final evaluation. Preliminary results indicate that VGT is feasible and safe in acute stroke patients when adhering to this standardized method.

Caregivers of persons with heart failure and stroke describe increased responsibilities after hospitalization. To better characterize the needs of caregivers who self-selected into the intervention, we conducted a convergent parallel mixed methods secondary analysis from our pilot study of The Heart Failure and Stroke Resilience Intervention for Caregivers (HEROIC) program. Using transcriptions of Visit 1, coders analyzed pre-defined domains of caregiving for features of perceived strength, neutrality, or challenge. The domains included a) Values (not rated); b) Caregiving Intensity; c) Dyadic Relationship; d) Social Support; e) Financial Resources; f) Home/Built Environment; g) Other Responsibilities of Caregiver; and h) Health/Health Care. Two coders identified salient quotes and rated the seven domains for each transcript. Discrepancies were resolved by group consensus. Data were then integrated with common demographic features and level of patient care need. Of the 20 caregivers, seven (35%) described low needs, 11 (55%) reported moderate needs, and two (10%) described high needs. The moderate/high needs group had worse self-reported health and caregiving-related outcomes when compared to the low needs group. Although a limited sample, this analysis highlights the spectrum of caregiving needs. While the HEROIC intervention was intended to capture caregivers with moderate/high needs, the self-selected inclusion of caregivers reporting low needs suggests that caregiving interventions broaden inclusion criteria. Quantitative measures of caregiving-related outcomes may miss caregivers who feel that they would benefit from targeted intervention. Overall, caregiving interventions that incorporate a whole-person approach have the potential to decrease caregiver burden and improve quality of life.

OBJECTIVE:Formalized stroke center care has improved morbidity and mortality from stroke, but transitional care after hospital discharge remains highly variable. This article provides a conceptual framework for transitional stroke care, summarizes data-driven practices, and reviews strategies for the successful implementation of programs that translate to success for patients and care partners. LATEST DEVELOPMENTS:The ideal transitional stroke care framework is largely driven by protocolized care delivery models aimed at the conduct of efficient diagnostic processes, adherence to effective treatments, and avoidance of common poststroke complications. A large-scale randomized clinical trial testing an early-supported discharge program (COMPASS-TC [Comprehensive Post-Acute Stroke Services transitional care]) was significantly limited by poor uptake, with only 35% of enrolled participants completing the prescribed intervention visit at implementation sites. There have been numerous single-center reports of benefits for hospitalized patients with stroke when postdischarge transitional care is well coordinated. The Joint Stroke Transitional Technology-Enhanced Program, an example of a standardized early supported discharge program, is an interprofessional, specialty program composed of a series of joint telemedicine visits for hospitalized patients with stroke. Using this model has demonstrated high value with the rate of visit completion with the stroke specialist greater than 80%, accelerated access to recovery resources, and lower 30-day hospital readmission rates compared with national standards. ESSENTIAL POINTS:Based on a holistic conceptual framework, implementation of a formalized transitional stroke care model optimizes success for both the patient with stroke and the comprehensive stroke center of care.

Stroke is a leading cause of death and disability worldwide, and the recovery process is significantly influenced by a multitude of factors beyond immediate medical treatment. Social and environmental determinants of health-conditions in which people are born, grow, work, live, and age-play a crucial role in the functional outcomes of stroke survivors, and addressing these factors is essential to ensure equitable care and optimal recovery. Previous scientific statements have discussed the effects of social isolation on cardiovascular and brain health, as well as strategies to reduce racial and ethnic inequities in stroke preparedness, care, recovery, and risk factor control. In this statement, we review the effect of factors such as social and environmental determinants on stroke functional outcome primarily but also secondary stroke prevention when relevant. In addition, we provide actionable considerations for addressing them to improve stroke outcomes; strategies include the identification of upstream factors, use of impactful policies, and use of implementation science frameworks to translate evidence-based practices into real-world settings. Current gaps for future research include understanding the effect of cultural considerations on stroke recovery, recognizing the interaction of social and environmental determinants of health with each other and with biological factors in determining stroke outcomes, and finding effective ways to address these factors in different environments to achieve best outcomes for all stroke survivors.

INTRODUCTION:Identifying modifiable, accessible dementia risk factors is critical for prevention. Worldwide surveys indicate that about half of adults do not meet recommended fluid intake and may be chronically underhydrated. METHODS:We examined associations between intracellular hydration markers and dementia risk in 13,535 participants from the Atherosclerosis Risk in Communities (ARIC) study and 395,802 individuals from Israel's Leumit Health Services. Serum sodium, glucose-corrected sodium, and tonicity were modeled using restricted cubic splines in adjusted Cox models of incident dementia. RESULTS:Across both cohorts, with up to 30 years of follow-up, dementia risk showed a nonlinear association with hydration markers. Risk began increasing within the mid-normal range, around 141 mmol/L for serum sodium and 287 mosmol/kg for tonicity, reaching a 1.5- to 3-fold increase at the upper end and beyond. DISCUSSION:These findings suggest hypertonic underhydration as early marker of dementia risk and support adequate water intake and glycemic control for dementia prevention.

Background and Purpose: The inflammatory response after ischemic and hemorrhagic stroke is associated with worse clinical outcomes through immune mediated production of pro- inflammatory cytokines. Repair proteins such as brain derived neurotrophic factor (BDNF) are expressed as part of the adaptive immune response. We assessed safety of moderate intensity exercise in the acute phase and its association with pro-inflammatory cytokines and BDNF expression. Methods: This was a prospective, single center, randomized, pilot of prescribed exercise for patients hospitalized with stroke. The intervention group was randomized to standard care plus two 20-minute in-bed cycle ergometry sessions per day during the first week after stroke. We measured serum concentrations of BDNF as primary outcome and interleukin(IL)-1β IL-6, IL-10, tumor necrosis factor(TNF)-α and National Institutes of Health Stroke Scale (NIHSS) score as secondary outcomes at days 1(T1), 3(T2) and 7(T3). Cerebrospinal fluid was collected in 4 patients with an external ventricular drain. We used Spearman’s Rho to assess associations of biomarker levels with treatment group. Results: A total of 15 patients with acute spontaneous intracerebral hemorrhage (ICH) and nine patients with acute ischemic stroke (AIS) were enrolled. Of 25 enrolled patients, mean age was 65.8 (SD, 16.3) years, and 10 (40%) were female. Median admission NIHSS score was 12 (interquartile range 6-17) in the intervention group (n=14) compared to 19 (14-24) in the control group (n=11). Seventy-four cycling sessions were performed in the intervention group for a mean of 98.9 (sd, 59.1) total minutes of cycling per patient. In the combined AIS/ICH cohort, a trend association of increased BDNF was observed at T2 in the intervention group compared to the control group (p=0.05). No serious adverse events were recorded. Conclusions: This is one of the first human trials to investigate exercise-induced modulation of inflammatory cytokine and trophic factor expression in the first week after stroke. Early moderate intense exercise was safe and showed small but promising changes in BDNF despite imbalances in clinical factors in this small study.

Introduction Tracheostomy is frequently performed in neurocritical patients to facilitate airway management and ventilator liberation. However, the optimal timing of tracheostomy remains controversial, particularly in stroke patients, where earlier intervention may impact recovery and healthcare resource utilization. This study evaluates the association between early (<14 days) versus late (>14 days) tracheostomy and key clinical outcomes in stroke and non-stroke neurocritical care patients. Methods A retrospective cohort study was conducted in a neuro-intensive care unit at an urban, quaternary care hospital. Adult patients (≥18 years) who underwent both percutaneous tracheostomy and gastrostomy between 2007 and 2013 were included. Demographics, admission Glasgow Coma Scale (GCS), hospital and intensive care unit (ICU) length of stay (LOS), ventilator days, reintubation rates, tracheostomy-related complications, costs, and discharge disposition were compared between stroke and non-stroke patients, as well as between early and late tracheostomy groups. Multivariable regression and competing risks models were used to adjust for confounders. Results Among 290 patients (145 stroke, 145 non-stroke), early tracheostomy was associated with significantly shorter ICU LOS (21.7 vs. 27.6 days, p < 0.01), reduced hospital LOS (32.4 vs. 38.9 days, p < 0.01), and lower total hospital costs ($121,645 vs. $157,304, p < 0.01) in stroke patients. Late tracheostomy was associated with a 2.7-fold increase in reintubation risk (p = 0.02) and 40% lower likelihood of discharge to rehabilitation (p < 0.01). In non-stroke patients, late tracheostomy was linked to longer ICU LOS (35.5 vs. 22.1 days, p < 0.01), extended hospitalization (50.8 vs. 32 days, p < 0.01), and increased costs ($206,184 vs. $128,788, p < 0.01). Tracheostomy-related complications were more frequent in early tracheostomy stroke patients (22.1% vs. 7.3%, p = 0.03), but this did not impact overall discharge outcomes. Conclusions Early tracheostomy in neurocritical patients, particularly those with stroke, is associated with shorter ICU stays, lower reintubation rates, and improved discharge to rehabilitation. While early tracheostomy carries a higher risk of procedural complications, its benefits in ICU efficiency and recovery support its role in evidence-based airway management strategies. Future prospective studies should focus on refining patient selection criteria for early tracheostomy and evaluating long-term functional outcomes in neurocritical care populations.

BACKGROUND AND PURPOSE:Prolonged venous transit (PVT+) is a marker of venous outflow; it is defined as the presence or absence of time-to-maximum ≥10 seconds timing in either the superior sagittal sinus or torcula. This novel perfusion imaging-based metric has been associated with higher odds of mortality and lower odds of functional recovery. This study aims to assess the relationship between PVT on admission perfusion imaging and length of hospital stay in large vessel occlusion strokes successfully reperfused with mechanical thrombectomy. MATERIALS AND METHODS:Patients with acute ischemic stroke with large vessel occlusions in the anterior circulation successfully treated with thrombectomy between January 2017 and September 2022 were retrospectively reviewed. The primary outcome was length of stay in the hospital due to the acute stroke event. Univariable and forward stepwise multivariable linear regressions were performed for the primary outcome. RESULTS:Of 109 patients meeting inclusion, median age was 71 (interquartile range [IQR] 62-80) years. Median hospital length of stay was significantly greater in PVT+ patients (9 [IQR 6-18] days) compared with PVT- patients (6 [IQR 4-12] days, P = .03). In multivariable regression, PVT+ was significantly associated with length of stay, and PVT+ was associated with approximately 2 additional days of hospital stay compared with PVT- (P = .03). CONCLUSIONS:In successfully reperfused large vessel occlusion strokes, PVT+ was associated with an additional 2 days of hospital stay on average compared with PVT- patients, when adjusting for other clinical covariables. This simple, novel imaging metric is robust in correlating with a range of short- and long-term clinical outcomes.

Background: The transition period after hospitalization for stroke is a vulnerable time for patients as all adapt to new physical, cognitive, or emotional changes and destabilized comorbid conditions. Transitional care programs designed for post-stroke care carry the promise of improved outcomes and reduced hospital readmission rates, however attendance rates to these scheduled visits in other stroke early supported discharge programs are reported as low as 35%. In addition to patient specific consequences, missed stroke clinic visits impact system efficiency and workflow which carry broad regional consequences. We sought to understand the impact of our early supported discharge program on hospital length of stay and clinic attendance patterns to prepare for ongoing iteration of this program. Methods: All hospitalized stroke patients who are discharged to home are enrolled in the Joint Stroke Transitional Technology-Enhanced Program (JSTTEP) and seen by a stroke specialist using telemedicine platform within the first 2 weeks of hospital discharge. Following JSTTEP, patients receive usual care which includes a stroke clinic visit 2-3 months after discharge, either by telemedicine or in-person based on patient preference and clinical needs. Results: There has been no change in demographics since the inception of JSTTEP in 2020 with the average age of patients 61 years, 40% female, and nearly 50% black. In calendar year 2023, 309 patients were enrolled in the JSTTEP following hospitalization for acute stroke. Of those, 277 (90%) completed the first JSTTEP telemedicine visit. The mean time from hospital discharge to the first JSTTEP visit was 7.6 days. Hospital length of stay has decreased from 4.5 days prior to JSTTEP to 4.0 days in 2023. Modified Rankin Scale scores at 90 days decreased from 2.2 to 1.1 in a subset of patients with available scores. Conclusion: Since the implementation of JSTTEP, hospital length of stay has decreased for stroke patients who are discharged to home. We note a high show rate to this clinic and suspect that there are a variety of contributors to these successes including close proximity to hospitalization, rapid attention to evolving post-discharge needs, interaction with stroke specialists, and use of telemedicine to facilitate access during a time period where driving is prohibited. The intentional design of the JSTTEP resulting in high level of engagement is likely a strong factor in the early success of the JSTTEP program.

Background Therapeutic activity after stroke is a component of early recovery strategies. Interactive video games have been shown to be safe as an adjunct rehabilitation therapy in the medical intensive care setting, but patients with neurologic disease were often excluded from those protocols. Objectives To evaluate the feasibility and safety of individualized interactive video game therapy in critically ill neurologic patients. Methods Adults admitted to the neurosciences critical care unit during the observation period were eligible for inclusion. Wii sports games with the potential to target common neurologic deficits were categorized by our interprofessional team. We collected information regarding the number of sessions attempted, time for setup, indications of use, patient/staff experience, and predefined safety events. Results Twelve sessions were completed in 9 patients, mean (SD) age 48.6 (18.1) years, and sessions were led by nursing and therapy teams. Prescribed video game therapy sessions targeted the following recovery domains: coordination (70%), balance (50%), endurance (30%), cognition (30%), fine motor control (30%), neglect (20%), engagement in activity (10%), and vision (30%). On average, 4.7 minutes were spent for setup and 18.8 minutes were spent playing video games. No safety issues were identified. All patients indicated that they enjoyed participating in video game therapy. Conclusions In this pilot study, prescriptive interactive video game therapy in early rehabilitation was feasible and safe in the neurosciences critical care setting. Video game therapy may be a valuable complement to existing rehabilitation for critically ill neurologic patients and warrants validation in a larger patient sample.

INTRODUCTION:The venous outflow profile (VOP) is a crucial yet often overlooked aspect affecting stroke outcomes. It plays a major role in the physiopathology of acute cerebral ischemia, as it accounts for both the upstream arterial collaterals and cerebral microperfusion. This enables it to circumvent the limitations of various arterial collateral evaluation systems, which often fail to consider impaired autoregulation and its impact on cerebral blood flow at the microcirculatory levels. In this narrative review, we will highlight the different parameters and modalities used to assess the VOP in acute ischemia. VO ASSESSMENT WITH DIFFERENT MODALITIES:CT parameters include cortical vein opacification score, interhemispheric difference of composite scores of the draining veins classifications on single-phase CT angiography (CTA), as well as the extent and velocity of optimal cortical venous filling on multiphase CTA. Differences in contrast administration and acquisition time render the single-phase CTA parameters less reliable. Perfusion parameters are semiautomated, thus offering greater reproducibility. These include time to peak and prolonged venous transit. Finally, the venous transit time is an MRI parameter. ASSOCIATIONS AND PROGNOSTIC IMPLICATIONS:VOP parameters' significance lies in their potential to predict tissue fate and, subsequently, clinical outcomes. Recent studies indicate that favorable VOP is independently associated with slower rates of infarct edema progression, smaller infarct volumes, and higher rates of functional independence after 90 days. Moreover, it is considered a predictor of recanalization success and the first-pass effect during mechanical thrombectomy. Conversely, an unfavorable VOP predicts futile recanalization and indicates a higher risk of reperfusion hemorrhage. Our aim is to explore these prognostic implications and their relevance in determining the utility of intracranial intervention.

Background Acute ischaemic stroke (AIS) is a leading cause of mortality and disability globally, with volume contracted state (VCS), as indicated by an elevated blood urea nitrogen to creatinine (BUN/Cr) ratio, potentially influencing outcomes. This study investigates the association between VCS and clinical outcomes in patients with AIS due to large vessel occlusion (LVO). Methods A retrospective cohort study was conducted involving 298 patients with LVO-AIS from two comprehensive stroke centres. Patients were divided into two groups based on BUN/Cr ratio: ≤20 (n=205) and >20 (n=93). Primary outcomes included 90-day mortality and unfavourable functional outcomes, defined as a modified Rankin Scale score of 3–6. Secondary outcomes included the successful reperfusion, haemorrhagic transformation and National Institutes of Health Stroke Scale score at discharge. Results Patients with a BUN/Cr ratio >20 had significantly higher 90-day mortality (35% vs 13%, p<0.001) and this association remained significant after adjusting for confounding factors (OR 2.20; 95% CI 1.11 to 4.39; p=0.024). However, VCS was not significantly associated with unfavourable functional outcomes at 90 days (OR 1.28; 95% CI 0.67 to 2.51; p=0.46). Age and initial stroke severity were more strongly associated with long-term functional outcomes. Conclusions VCS is associated with higher odds of 90-day mortality in patients with LVO-AIS but not with unfavourable functional outcomes. These findings suggest the need for further research into the role of hydration management in improving survival in patients with AIS, potentially informing future treatment protocols.

Background and Purpose: Prolonged length of stay (LOS) following a stroke is associated with unfavorable clinical outcomes. Factors predicting LOS in medium vessel occlusion (MeVO), impacting up to 40% of acute ischemic stroke (AIS) cases, remain underexplored. This study aims to investigate the predictors of LOS in AIS-MeVO. Methods: We conducted a retrospective analysis of prospectively maintained stroke databases, comprising of AIS cases with MeVO in the anterior circulation, assessed by adequate CT perfusion (CTP). Baseline and clinical data were obtained from electronic health records. Alberta Stroke Program Early CT Scores (ASPECTS) were calculated from noncontrast head CT. The perfusion mismatch volume (Tmax > 6s minus rCBF <30%) volume was reported from CTP. Multiple regression was employed to examine the relationship between baseline parameters and hospital LOS. Results: A total of 133 patients (median age 71 [IQR 63-80] years, 59.4% females) were included in the study cohort). The perfusion mismatch volume significantly positively correlated with LOS (r=0.264, p=0.004). After adjusting for age, sex, hypertension, diabetes, prior stroke or TIA, admission NIHSS, ASPECTS, Tan score, intravenous thrombolysis, mechanical thrombectomy, and hemorrhagic transformation, a larger mismatch volume remained independently associated with longer hospital stays (β=0.209, 95%CI 0.006-0.412, p=0.045). Additional significant determinants of longer hospital stay included admission NIHSS (β=0.250, 95%CI 0.060-0.440, p=0.010) and mechanical thrombectomy (MT) (β=0.208, 95%CI 0.006-0.410, p=0.044). Among patients who underwent MT (N=83), multiple regression analysis incorporating both perfusion mismatch volume and admission NIHSS revealed that perfusion mismatch volume remained independently associated with LOS (β=0.248, 95%CI 0.019-0.471, p=0.033), while admission NIHSS did not retain significance (β=0.208, 95%CI -0.019-0.433, p=0.071). Conclusions: In our cohort of AIS patients with MeVO in the anterior circulation, and particularly in those who underwent MT, the perfusion mismatch volume serves as an independent predictor of LOS. These findings offer critical valuable insights in clinical assessments and decision-making protocols of MT in AIS-MeVO.

BACKGROUND:Stroke burden is increasing in sub-Saharan Africa. We studied differences in stroke risk factors, hospital characteristics, and outcomes between adults with first-ever and recurrent stroke in Zambia. METHODS:We retrospectively collected demographics, clinical presentation, medical history, and in-hospital outcomes and at 90-days post-discharge from adults admitted to the University Teaching Hospital in Lusaka, Zambia between October 2018 - March 2019. We compared descriptive statistics between participants with first-ever and recurrent strokes using t-tests for continuous parametric variables, Wilcoxon rank-sum tests for continuous nonparametric variables, and chi-square or Fisher exact tests for categorical variables. RESULTS:This stroke cohort (n = 324) consisted of 253 (78 %) patients with first-ever stroke and 71 (22 %) hospitalized with recurrent stroke. Adults with first-ever stroke were younger than individuals with recurrent stroke (58 ± 18 vs 66 ± 14 years, p < 0.001), more likely to present with undiagnosed hypertension (19 % vs. 6 %, p = 0.01), and had higher rates of intracerebral hemorrhage (32 % vs. 15 %, p = 0.03). Adults with recurrent stroke were more likely to have medical comorbidities, including prior diagnosis of hypertension (90 % vs. 77 %, p = 0.02), atrial fibrillation (26 % vs. 6 %, p = 0.01), and had higher rates of aspiration pneumonia (30 % vs. 12 %, p = 0.001). In-hospital mortality did not differ between groups (31 % in recurrent vs. 22 % in first-ever, p = 0.12) but those with recurrent stroke had higher 90-day mortality (59 % vs 36 %, p = 0.001). DISCUSSION:Our findings suggest improvements in both primary and secondary prevention strategies and programs are needed. Improved hypertension screening and diagnosis while developing chronic disease management programs are necessary for stroke prevention.

Background and Objectives: Daily rounds provide an opportunity for interprofessional collaboration and patient/family engagement, which are critical to stroke care. As part of a quality improvement program, we conducted a baseline assessment to examine interprofessional collaboration and patient/family engagement during the current rounding process in a 12-bed comprehensive stroke center. Findings from the baseline assessment will be used to inform the development, implementation, and evaluation of a new rounding model. Methods: The baseline assessment used a mixed-methods approach with a convergent parallel design. Although observations of the current rounding process were conducted to quantitatively assess interprofessional collaboration and patient/family engagement on rounds, qualitative interviews were conducted with different stakeholders to identify strengths and weaknesses of the current rounding process, as well as suggestions for facilitating interprofessional collaboration and patient/family engagement. Results: We observed 103 table rounds and 99 bedside rounds and conducted 30 interviews with patients, families, and clinicians. Although the current process was perceived to facilitate interprofessional collaboration, the participation of nurses and other health care professionals on rounds was inconsistent due to competing clinical duties. Good practices for engaging patients and families during bedside rounds were also performed inconsistently. Conclusions: These findings lead to recommendations for revising the rounding process with poststroke patients, utilizing a more interprofessional collaborative approach with focus on patient/family engagement.

Introduction Family caregivers of persons with advanced heart failure (HF) and stroke bear increased responsibilities as care recipients recover from acute hospitalization. Few formalized supports are available. We conducted a feasibility pilot of a caregiver-targeted support program: Heart Failure and Stroke Resilience Intervention for Caregivers (HEROIC) using a randomized waitlist-control design. Here we sought to understand similarities and differences in participation between HF and stroke enrolled caregiver participants. Methods We recruited caregivers of HF and stroke patients via review of the electronic health record and/or provider referral after the first follow-up visit. Baseline surveys were collected electronically. Enrolled participants were randomized to the intervention or waitlist group. HEROIC consists of 5 nurse-led, remote sessions over a 10-week period. Components incorporate resilience resources including emphasis on caregiver life purpose and values, goal-setting for self-care, social support, community and palliative care resources. Characteristics of participants were analyzed using descriptive statistics and t-test or chi-square as appropriate. Results We identified 158 potential caregivers through electronic health records and provider referral. 65% (n=103) were reached by phone and 57/103 (55%) were eligible for participation. Fifty caregivers consented but only 31 completed baseline data collection and were randomized. Reasons for drop out included loss to follow-up, patient death and too many competing demands. Caregivers were on average 58.4 years old (SD: 11.4), 84% female and 45% Black. They supported patients with moderate to severe functional impairment and 5.5 ± 2.3 instrumental activities of daily living (IADL) on average. Over half of caregivers reported financial strain. Caregivers reported moderate caregiver strain using the Modified Caregiver Strain Index (Mean: 11.9, SD: 6.0). Most caregivers supported persons with HF (n=19). The only statistically significant difference noted between HF and stroke caregivers was gender; more caregivers of stroke patients were male. Conclusions Similarities in baseline characteristics of HF and stroke caregivers suggest similar caregiving experiences. HEROIC or other early post-hospital caregiver support interventions may appeal to caregivers to increase resilience to the stresses of transitions of care but recruitment strategies require additional consideration.