Dawn M Bravata1, Joanne Daggy2, Jared Brosch2, Jason J Sico2, Fitsum Baye2, Laura J Myers2, Christianne L Roumie2, Eric Cheng2, Jessica Coffing2, Greg Arling2. 1. From the VHA Health Services Research and Development (HSR&D), Stroke Quality Enhancement Research Initiative (QUERI), Indianapolis, IN (D.M.B., J.D., F.B., L.J.M., G.A.); VHA HSR&D Center for Health Information and Communication (CHIC), Richard L. Roudebush VHA Medical Center, Indianapolis, IN (D.M.B., J.D., L.J.M., J.C.); Department of Medicine (D.M.B., L.J.M.), Department of Neurology (D.M.B., J.B.), and Department of Biostatistics (J.D., F.B.), Indiana University School of Medicine, Indianapolis; Department of Sociology, Indiana University School of Liberal Arts, Indiana University, Purdue University Indianapolis (G.A.); Regenstrief Institute, Indianapolis, IN (D.M.B., G.A.); Department of Neurology, Department of Internal Medicine, and Center for Neuroepidemiological and Clinical Neurological Research, Yale University School of Medicine, New Haven, CT (J.J.S.); HSR&D, GRECC, and Clinical Research Training Center of Excellence, Veterans Affairs-Tennessee Valley Healthcare System, Nashville, TN (C.L.R.); Institute of Medicine and Public Health, Vanderbilt University, Nashville, TN (C.L.R.); Department of Neurology, VA Greater Los Angeles Healthcare System, Los Angeles, CA (E.C.); and Department of Neurology, University of California at Los Angeles (E.C.). Dawn.Bravata2@va.gov. 2. From the VHA Health Services Research and Development (HSR&D), Stroke Quality Enhancement Research Initiative (QUERI), Indianapolis, IN (D.M.B., J.D., F.B., L.J.M., G.A.); VHA HSR&D Center for Health Information and Communication (CHIC), Richard L. Roudebush VHA Medical Center, Indianapolis, IN (D.M.B., J.D., L.J.M., J.C.); Department of Medicine (D.M.B., L.J.M.), Department of Neurology (D.M.B., J.B.), and Department of Biostatistics (J.D., F.B.), Indiana University School of Medicine, Indianapolis; Department of Sociology, Indiana University School of Liberal Arts, Indiana University, Purdue University Indianapolis (G.A.); Regenstrief Institute, Indianapolis, IN (D.M.B., G.A.); Department of Neurology, Department of Internal Medicine, and Center for Neuroepidemiological and Clinical Neurological Research, Yale University School of Medicine, New Haven, CT (J.J.S.); HSR&D, GRECC, and Clinical Research Training Center of Excellence, Veterans Affairs-Tennessee Valley Healthcare System, Nashville, TN (C.L.R.); Institute of Medicine and Public Health, Vanderbilt University, Nashville, TN (C.L.R.); Department of Neurology, VA Greater Los Angeles Healthcare System, Los Angeles, CA (E.C.); and Department of Neurology, University of California at Los Angeles (E.C.).
Abstract
BACKGROUND AND PURPOSE: The Veterans Health Administration has engaged in quality improvement to improve vascular risk factor control. We sought to examine blood pressure (<140/90 mm Hg), lipid (LDL [low-density lipoprotein] cholesterol <100 mg/dL), and glycemic control (hemoglobin A1c <9%), in the year post-hospitalization for acute ischemic stroke or acute myocardial infarction (AMI). METHODS: We identified patients who were hospitalized (fiscal year 2011) with ischemic stroke, AMI, congestive heart failure, transient ischemic attack, or pneumonia/chronic obstructive pulmonary disease. The primary analysis compared risk factor control after incident ischemic stroke versus AMI. Facilities were included if they cared for ≥25 ischemic stroke and ≥25 AMI patients. A generalized linear mixed model including patient- and facility-level covariates compared risk factor control across diagnoses. RESULTS: Forty thousand two hundred thirty patients were hospitalized (n=75 facilities): 2127 with incident ischemic stroke and 4169 with incident AMI. Fewer stroke patients achieved blood pressure control than AMI patients (64%; 95% confidence interval, 0.62-0.67 versus 77%; 95% confidence interval, 0.75-0.78; P<0.0001). After adjusting for patient and facility covariates, the odds of blood pressure control were still higher for AMI than ischemic stroke patients (odds ratio, 1.39; 95% confidence interval, 1.21-1.51). There were no statistical differences for AMI versus stroke patients in hyperlipidemia (P=0.534). Among patients with diabetes mellitus, the odds of glycemic control were lower for AMI than ischemic stroke patients (odds ratio, 0.72; 95% confidence interval, 0.54-0.96). CONCLUSIONS: Given that hypertension control is a cornerstone of stroke prevention, interventions to improve poststroke hypertension management are needed.
BACKGROUND AND PURPOSE: The Veterans Health Administration has engaged in quality improvement to improve vascular risk factor control. We sought to examine blood pressure (<140/90 mm Hg), lipid (LDL [low-density lipoprotein] cholesterol <100 mg/dL), and glycemic control (hemoglobin A1c <9%), in the year post-hospitalization for acute ischemic stroke or acute myocardial infarction (AMI). METHODS: We identified patients who were hospitalized (fiscal year 2011) with ischemic stroke, AMI, congestive heart failure, transient ischemic attack, or pneumonia/chronic obstructive pulmonary disease. The primary analysis compared risk factor control after incident ischemic stroke versus AMI. Facilities were included if they cared for ≥25 ischemic stroke and ≥25 AMI patients. A generalized linear mixed model including patient- and facility-level covariates compared risk factor control across diagnoses. RESULTS: Forty thousand two hundred thirty patients were hospitalized (n=75 facilities): 2127 with incident ischemic stroke and 4169 with incident AMI. Fewer strokepatients achieved blood pressure control than AMI patients (64%; 95% confidence interval, 0.62-0.67 versus 77%; 95% confidence interval, 0.75-0.78; P<0.0001). After adjusting for patient and facility covariates, the odds of blood pressure control were still higher for AMI than ischemic strokepatients (odds ratio, 1.39; 95% confidence interval, 1.21-1.51). There were no statistical differences for AMI versus strokepatients in hyperlipidemia (P=0.534). Among patients with diabetes mellitus, the odds of glycemic control were lower for AMI than ischemic strokepatients (odds ratio, 0.72; 95% confidence interval, 0.54-0.96). CONCLUSIONS: Given that hypertension control is a cornerstone of stroke prevention, interventions to improve poststroke hypertension management are needed.
Authors: Santosh B Murthy; Ivan Diaz; Xian Wu; Alexander E Merkler; Costantino Iadecola; Monika M Safford; Kevin N Sheth; Babak B Navi; Hooman Kamel Journal: Stroke Date: 2019-11-27 Impact factor: 7.914