Acute stroke care and clinical outcomes have improved significantly at hospitals participating in the American Heart Association/American Stroke Association's Get With The Guidelines-Stroke program, according to a large study in Circulation: Cardiovascular Quality and Outcomes, a journal of the American Heart Association.
To better characterize contemporary stroke patients and determine the impact of Get With The Guidelines-Stroke participation, researchers analyzed several aspects of the first 1 million stroke patients at 1,392 hospitals participating in the quality improvement initiative from 2003 to 2009.
Each year more than 795,000 Americans suffer a stroke and another 200,000 to 500,000 present with a transient ischemic attack (TIA), often called a "warning stroke."
"We found that the opportunities to provide guideline-recommended care addressed by the performance measures were substantially met for stroke and TIA patients, with overall composite care improving substantially from 72 percent in 2003 to 93 percent in 2009," said Gregg C. Fonarow, M.D., lead author of the study and professor of cardiovascular medicine at the University of California-Los Angeles. "Stroke and TIA patients receiving all of the care measures for which they were eligible increased from 44 percent in 2003 to 84 percent in 2009."
Patients in the database were an average 70.1 years of age. Of all strokes analyzed, ischemic strokes (caused by a blood clot blocking a blood vessel in the brain) were the most common (60.2 percent), followed by TIAs (22.8 percent), intracerebral hemorrhages (10.9 percent), subarachnoid hemorrhages (3.5 percent) and unclassified strokes (2.7 percent).
In-hospital mortality was highest among patients suffering hemorrhagic strokes (caused by blood leaking into the brain tissue). Hospital participation in Get With The Guidelines-Stroke made the biggest impact on stroke death rates among the most common stroke types -- ischemic stroke and TIA -- reducing the risk-adjusted odds of in-hospital mortality rate after ischemic stroke by 10 percent.
"The study has shown what is of primary importance to those who rely on the nation's hospitals for optimal stroke care: the implementation of Get With The Guidelines-Stroke has resulted in substantial improvement in care at a rapid pace in a variety of hospital types and in multiple hospitals, simultaneously," said Lee H. Schwamm, M.D., study co-author, chair of the Get With The Guidelines National Steering Committee and director of the TeleStroke and Acute Stroke Services at Massachusetts General Hospital in Boston, Mass.
The initiative is making a landmark contribution to stroke patients of today and tomorrow, said Clyde W. Yancy, M.D., president of the American Heart Association.
"Not only has quality improved, but lives are being saved and subsequent strokes are being thwarted," said Yancy, medical director at the Baylor Heart and Vascular Institute in Dallas. "These findings demonstrate the true potential of implementing best practices within a care delivery system and the approach taken by the Get With The Guidelines team is a template for the future." To facilitate better treatment and outcomes for stroke patients, the American Heart Association/American Stroke Association has launched Target: Stroke. The program will arm healthcare providers with information and tools to improve the use of the intravenous thrombolysis recombinent tissue plasminogen activator (IV rt-PA), the only drug approved by the U.S. Food and Drug Administration for the urgent treatment of ischemic stroke.
"An earlier analysis of Get With The Guidelines-Stroke data found that despite clinical trial evidence of improved outcomes for stroke patients treated early with an intravenous clot buster, only 27.4 percent of patients treated with IV rt-PA had door-to-needle times within 60 minutes," Yancy said. "The goal for Target: Stroke is to achieve a door-to-needle time within 60 minutes or less in at least 50 percent of ischemic stroke patients treated with a clot-busting drug.
"The new initiative builds on this robust database we have from Get With The Guidelines to help us identify best practices that enable hospitals to further improve quality of care and outcomes in acute stroke care."
Additional co-authors are Mathew J. Reeves, Ph.D.; Eric E. Smith, M.D., M.P.H.; Jeffrey L. Saver, M.D.; Xin Zhao, M.S.; DaiWai Olson, Ph.D.; Adrian F Hernandez, M.D. M.H.S.; and Eric D. Peterson, M.D., M.P.H. Author disclosures are on the manuscript.
Get With The Guidelines-Stroke is supported in part by an unrestricted educational grant from Merck/Schering-Plough Pharmaceutical.
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