BACKGROUND AND PURPOSE: Secondary stroke prevention treatments vary in different regions of the US. We determined the degree to which guideline-recommended stroke treatments vary by region for patients treated at hospitals participating in a voluntary national quality improvement program, Get with ehe Guidelines--Stroke. METHODS: Receipt of 8 guideline-recommended treatments (intravenous tissue-type plasminogen activator, antihypertensives, antithrombotics, anticoagulants for atrial fibrillation, deep vein thrombosis prophylaxis, lipid-lowering medications at discharge, smoking cessation counseling, weight loss education) and defect-free care were compared in 4 US regions among eligible patients with ischemic stroke and transient ischemic attack; there was adjustment for patient demographics, medical history, and hospital characteristics. RESULTS: Among 991 995 admissions (South, 37%; Northeast, 27.6%; Midwest, 19.3%; West, 15.9%). Receipt varied regionally for tissue-type plasminogen activator (58.2%-67.8%), lipid-lowering medications (72.5%-75.7%), antihypertensives (80.1%-83.6%), antithrombotics (95.6%-96.8%), deep vein thrombosis prophylaxis (88.0%-91.4%), weight loss education (49.3%-54.7%), and defect-free care (72.1%-76.5%). In adjusted analyses, patients in the South had lower odds of use of intravenous tissue-type plasminogen activator (OR [95% CI]; 0.82 [0.69-0.97]), antihypertensives (0.82 [0.67-0.99]), and defect-free care (0.83 [0.75-0.92]); but, they were more likely to receive lipid-lowering medications (1.28 [1.05-1.54]) compared with those in the Northeast. Patients in the Midwest had lower odds of intravenous tissue-type plasminogen activator administration (0.82 [0.68-0.99]) and defect-free care (0.81 [0.72-0.92]). Those in the West had lower odds of antihypertensives (0.81 [0.67-0.99]), but had greater odds of receiving lipid-lowering medications (1.26 [1.03-1.53]). CONCLUSIONS: Despite relatively high rates of adherence to stroke-related therapies in Get With The Guidelines-Stroke hospitals, regional variations exist, with over one quarter of patients receiving suboptimal care. Systematic improvements may lead to better patient outcomes.
BACKGROUND AND PURPOSE: Secondary stroke prevention treatments vary in different regions of the US. We determined the degree to which guideline-recommended stroke treatments vary by region for patients treated at hospitals participating in a voluntary national quality improvement program, Get with ehe Guidelines--Stroke. METHODS: Receipt of 8 guideline-recommended treatments (intravenous tissue-type plasminogen activator, antihypertensives, antithrombotics, anticoagulants for atrial fibrillation, deep vein thrombosis prophylaxis, lipid-lowering medications at discharge, smoking cessation counseling, weight loss education) and defect-free care were compared in 4 US regions among eligible patients with ischemic stroke and transient ischemic attack; there was adjustment for patient demographics, medical history, and hospital characteristics. RESULTS: Among 991 995 admissions (South, 37%; Northeast, 27.6%; Midwest, 19.3%; West, 15.9%). Receipt varied regionally for tissue-type plasminogen activator (58.2%-67.8%), lipid-lowering medications (72.5%-75.7%), antihypertensives (80.1%-83.6%), antithrombotics (95.6%-96.8%), deep vein thrombosis prophylaxis (88.0%-91.4%), weight loss education (49.3%-54.7%), and defect-free care (72.1%-76.5%). In adjusted analyses, patients in the South had lower odds of use of intravenous tissue-type plasminogen activator (OR [95% CI]; 0.82 [0.69-0.97]), antihypertensives (0.82 [0.67-0.99]), and defect-free care (0.83 [0.75-0.92]); but, they were more likely to receive lipid-lowering medications (1.28 [1.05-1.54]) compared with those in the Northeast. Patients in the Midwest had lower odds of intravenous tissue-type plasminogen activator administration (0.82 [0.68-0.99]) and defect-free care (0.81 [0.72-0.92]). Those in the West had lower odds of antihypertensives (0.81 [0.67-0.99]), but had greater odds of receiving lipid-lowering medications (1.26 [1.03-1.53]). CONCLUSIONS: Despite relatively high rates of adherence to stroke-related therapies in Get With The Guidelines-Stroke hospitals, regional variations exist, with over one quarter of patients receiving suboptimal care. Systematic improvements may lead to better patient outcomes.
Authors: Annastazia E Learoyd; Lisa Woodhouse; Laurence Shaw; Nikola Sprigg; Daniel Bereczki; Eivind Berge; Valeria Caso; Hanne Christensen; Ronan Collins; Anna Czlonkowska; Anwar El Etribi; Tracy D Farr; John Gommans; Ann-Charlotte Laska; George Ntaios; Serefnur Ozturk; Stuart J Pocock; Kameshwar Prasad; Joanna M Wardlaw; Kevin C Fone; Philip M Bath; Rebecca C Trueman Journal: Transl Stroke Res Date: 2017-07-27 Impact factor: 6.829
Authors: Michael J Lyerly; Karen C Albright; Amelia K Boehme; Reza Bavarsad Shahripour; James T Houston; Pawan V Rawal; Niren Kapoor; Muhammad Alvi; April Sisson; Anne W Alexandrov; Andrei V Alexandrov Journal: J Neurol Disord Stroke Date: 2013-09-13
Authors: Takeshi Hiu; Zoya Farzampour; Jeanne T Paz; Eric Hou Jen Wang; Corrine Badgely; Andrew Olson; Kristina D Micheva; Gordon Wang; Robin Lemmens; Kevin V Tran; Yasuhiro Nishiyama; Xibin Liang; Scott A Hamilton; Nancy O'Rourke; Stephen J Smith; John R Huguenard; Tonya M Bliss; Gary K Steinberg Journal: Brain Date: 2015-12-18 Impact factor: 13.501
Authors: Jean-Pierre Bassand; Gabriele Accetta; Wael Al Mahmeed; Ramon Corbalan; John Eikelboom; David A Fitzmaurice; Keith A A Fox; Haiyan Gao; Samuel Z Goldhaber; Shinya Goto; Sylvia Haas; Gloria Kayani; Karen Pieper; Alexander G G Turpie; Martin van Eickels; Freek W A Verheugt; Ajay K Kakkar Journal: PLoS One Date: 2018-01-25 Impact factor: 3.240