Jana Jackova1, Petra Sedova2, Robert D Brown3, Tomas Bryndziar1, Miroslav Zvolsky4, Josef Bednarik5, Robert Mikulik6. 1. International Clinical Research Centre, St Anne's University Hospital, Brno, Czech Republic; Faculty of Medicine, Masaryk University, Brno, Czech Republic. 2. International Clinical Research Centre, St Anne's University Hospital, Brno, Czech Republic; Faculty of Medicine, Masaryk University, Brno, Czech Republic; Department of Neurology, St Anne's University Hospital, Brno, Czech Republic; Department of Internal Medicine, Haematology and Oncology, University Hospital Brno, Brno, Czech Republic; Department of Neurology, Mayo Clinic, Rochester, Minnesota. 3. Department of Neurology, Mayo Clinic, Rochester, Minnesota. 4. Institute for Health Information and Statistics of the Czech Republic, Prague, Czech Republic. 5. Faculty of Medicine, Masaryk University, Brno, Czech Republic; Department of Neurology, University Hospital Brno, Brno, Czech Republic. 6. International Clinical Research Centre, St Anne's University Hospital, Brno, Czech Republic; Faculty of Medicine, Masaryk University, Brno, Czech Republic; Department of Neurology, St Anne's University Hospital, Brno, Czech Republic. Electronic address: mikulik@hotmail.com.
Abstract
BACKGROUND AND PURPOSE: Administration of evidence-based pharmacotherapy improves stroke outcome while the use of non-evidence-based medications may not be of benefit and leads to unnecessary patient care costs. The aim of our study was to determine the frequency of guideline-approved and guideline-disapproved pharmacotherapy use in acute stroke management in the Czech Republic (CR). METHODS: Using the ICD-10 codes, 500 stroke and transient ischemic attack (TIA) patients were randomly selected (random selection of 10 hospitals and then 50 patients from each hospital) from the National Registry of Hospitalized Patients for strokes occurring in 2011. Discharge summaries were reviewed for medications prescribed during hospitalization and at discharge. RESULTS: Of the 500 requested discharge summaries, 484 were available for review (response rate 97%). Up to 479 (96%) summaries were sufficient for evaluation and of these, 393 were confirmed to have a stroke or TIA diagnosis. Brain imaging (computed tomography or magnetic resonance imaging) was performed in 97% of the 393 cases. Intravenous thrombolysis was administered to 7% of patients with ischemic stroke (rate was 0%-25% in different hospitals). Up to 97% of patients with ischemic events (TIA or ischemic stroke) were treated with antiplatelets or anticoagulants. At least 1 non-evidence-based medication was administered to 28% of the 393 patients (rate was 5%-89% in different hospitals). CONCLUSIONS: Guideline-disapproved pharmacotherapy is common in stroke and TIA patients in the CR and processes should be put into place to lessen the frequency of their use. The use of guideline-approved medications is also high and should be further promoted.
BACKGROUND AND PURPOSE: Administration of evidence-based pharmacotherapy improves stroke outcome while the use of non-evidence-based medications may not be of benefit and leads to unnecessary patient care costs. The aim of our study was to determine the frequency of guideline-approved and guideline-disapproved pharmacotherapy use in acute stroke management in the Czech Republic (CR). METHODS: Using the ICD-10 codes, 500 stroke and transient ischemic attack (TIA) patients were randomly selected (random selection of 10 hospitals and then 50 patients from each hospital) from the National Registry of Hospitalized Patients for strokes occurring in 2011. Discharge summaries were reviewed for medications prescribed during hospitalization and at discharge. RESULTS: Of the 500 requested discharge summaries, 484 were available for review (response rate 97%). Up to 479 (96%) summaries were sufficient for evaluation and of these, 393 were confirmed to have a stroke or TIA diagnosis. Brain imaging (computed tomography or magnetic resonance imaging) was performed in 97% of the 393 cases. Intravenous thrombolysis was administered to 7% of patients with ischemic stroke (rate was 0%-25% in different hospitals). Up to 97% of patients with ischemic events (TIA or ischemic stroke) were treated with antiplatelets or anticoagulants. At least 1 non-evidence-based medication was administered to 28% of the 393 patients (rate was 5%-89% in different hospitals). CONCLUSIONS: Guideline-disapproved pharmacotherapy is common in stroke and TIApatients in the CR and processes should be put into place to lessen the frequency of their use. The use of guideline-approved medications is also high and should be further promoted.
Authors: Kamil Chwojnicki; Danuta Ryglewicz; Bogdan Wojtyniak; Paweł Zagożdżon; Anna Członkowska; Tadeusz Jędrzejczyk; Bartosz Karaszewski; Grzegorz Kozera; Marek Gierlotka; Majid Ezzati; Tomasz Zdrojewski Journal: Front Neurol Date: 2018-03-13 Impact factor: 4.003