Carlos Abanto1, Angela K Ulrich2, Ana Valencia3, Víctor Dueñas4, Silvia Montano5, David Tirschwell6, Joseph Zunt7. 1. Instituto Nacional de Ciencias Neurológicas, Departamento de Enfermedades Neurovasculares, Jirón Ancash 1271, Barrios Altos, Lima 01, Peru. Electronic address: carlosabantoa@yahoo.com. 2. University of Washington, Department of Global Health, 1959 NE Pacific Street, Box 357965, Seattle, WA 98195-7965, United States. Electronic address: ulric063@umn.edu. 3. Instituto Nacional de Ciencias Neurológicas, Departamento de Enfermedades Neurovasculares, Jirón Ancash 1271, Barrios Altos, Lima 01, Peru. 4. Complejo Hospitalario Alberto Leopoldo Barton Thompson, Av Argentina 3525, Callao 07001, Peru. 5. Instituto de Medicina Tropical, Daniel Alcides Carrión, Universidad Nacional Mayor de San Marcos, Lima, Peru. 6. Harborview Medical Center, Department of Neurology, 325 Ninth Ave Seattle, WA 98104, United States. Electronic address: tirsch@uw.edu. 7. Harborview Medical Center, Department of Neurology, 325 Ninth Ave Seattle, WA 98104, United States. Electronic address: zunt@u.washington.edu.
Abstract
BACKGROUND: Little is known about adherence to American Heart Association/American Stroke Association (AHA/ASA) stroke performance measures in developing countries like Peru. AIMS: We assessed adherence and determined factors associated with adherence to the AHA/ASA stroke performance measures at a reference center for neurological diseases in Lima, Peru. METHODS: We conducted a retrospective chart review of 150 stroke patients admitted to the Neurological Institute of Neurological Science from 2014 to 2016 to ascertain adherence to 15 different AHA/ASA stroke performance measures. Adherence was measured as a simple proportion, with both single and composite measures. Associations were analyzed with nonparametric statistics and multivariate logistic regression. RESULTS: Mean adherence to AHA/ASA stroke performance measures was 47%. We observed a statistically significant relationship between adherence to ischemic stroke performance measures and being married (OR = 3.78, 95% CI: 1.05-13.55), as well as an inverse relationship with an onset of symptoms of greater than 4.5 h prior to arrival at the hospital compared to those with ≤ 4.5 h (OR = 0.14, 95% CI: 0.02-0.97). Compared to patients with a lower National Institutes of Health Stroke Scale (NIHSS) score (<13), those with a score of ≥13 were less likely to have good adherence (OR = 0.11, 95% CI: 0.04-0.31). CONCLUSIONS: The mean composite measure of adherence to internationally recognized standards of stroke management in our Peruvian institution was below the level needed for an achievement award by AHA/ASA. An intervention targeted toward stroke prevention and training could lead to improved outcomes of stroke patients in Peru.
BACKGROUND: Little is known about adherence to American Heart Association/American Stroke Association (AHA/ASA) stroke performance measures in developing countries like Peru. AIMS: We assessed adherence and determined factors associated with adherence to the AHA/ASAstroke performance measures at a reference center for neurological diseases in Lima, Peru. METHODS: We conducted a retrospective chart review of 150 strokepatients admitted to the Neurological Institute of Neurological Science from 2014 to 2016 to ascertain adherence to 15 different AHA/ASAstroke performance measures. Adherence was measured as a simple proportion, with both single and composite measures. Associations were analyzed with nonparametric statistics and multivariate logistic regression. RESULTS: Mean adherence to AHA/ASAstroke performance measures was 47%. We observed a statistically significant relationship between adherence to ischemic stroke performance measures and being married (OR = 3.78, 95% CI: 1.05-13.55), as well as an inverse relationship with an onset of symptoms of greater than 4.5 h prior to arrival at the hospital compared to those with ≤ 4.5 h (OR = 0.14, 95% CI: 0.02-0.97). Compared to patients with a lower National Institutes of Health Stroke Scale (NIHSS) score (<13), those with a score of ≥13 were less likely to have good adherence (OR = 0.11, 95% CI: 0.04-0.31). CONCLUSIONS: The mean composite measure of adherence to internationally recognized standards of stroke management in our Peruvian institution was below the level needed for an achievement award by AHA/ASA. An intervention targeted toward stroke prevention and training could lead to improved outcomes of strokepatients in Peru.
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