Impact of Evidence‐Based Stroke Care on Patient Outcomes: A Multilevel Analysis of an International Study

Medientyp: E-Artikel
Titel: Impact of Evidence‐Based Stroke Care on Patient Outcomes: A Multilevel Analysis of an International Study
Beteiligte: Muñoz Venturelli, Paula; Li, Xian; Middleton, Sandy; Watkins, Caroline; Lavados, Pablo M.; Olavarría, Verónica V.; Brunser, Alejandro; Pontes‐Neto, Octavio; Santos, Taiza E. G.; Arima, Hisatomi; Billot, Laurent; Hackett, Maree L.; Song, Lily; Robinson, Thompson; Anderson, Craig S.; Mead, Gillian; De Silva, H. Asita; Pandian, Jeyaraj D.; Lin, Ruey‐Tay; Lee, Tsong‐Hai; Cui, Liying; Peng, Bin; Heritier, Stephane; Lindley, Richard; [...]
Erschienen: Ovid Technologies (Wolters Kluwer Health), 2019
Erschienen in: Journal of the American Heart Association
Sprache: Englisch
DOI: 10.1161/jaha.119.012640
ISSN: 2047-9980
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Beschreibung: <jats:sec xml:lang="en"> <jats:title>Background</jats:title> <jats:p xml:lang="en"> The uptake of proven stroke treatments varies widely. We aimed to determine the association of evidence‐based processes of care for acute ischemic stroke ( <jats:styled-content style="fixed-case">AIS</jats:styled-content> ) and clinical outcome of patients who participated in the HEADPOST (Head Positioning in Acute Stroke Trial), a multicenter cluster crossover trial of lying flat versus sitting up, head positioning in acute stroke. </jats:p> </jats:sec> <jats:sec xml:lang="en"> <jats:title>Methods and Results</jats:title> <jats:p xml:lang="en"> Use of 8 <jats:styled-content style="fixed-case">AIS</jats:styled-content> processes of care were considered: reperfusion therapy in eligible patients; acute stroke unit care; antihypertensive, antiplatelet, statin, and anticoagulation for atrial fibrillation; dysphagia assessment; and physiotherapist review. Hierarchical, mixed, logistic regression models were performed to determine associations with good outcome (modified Rankin Scale scores 0–2) at 90 days, adjusted for patient and hospital variables. Among 9485 patients with AIS, implementation of all processes of care in eligible patients, or “defect‐free” care, was associated with improved outcome (odds ratio, 1.40; 95% CI, 1.18–1.65) and better survival (odds ratio, 2.23; 95% <jats:styled-content style="fixed-case">CI</jats:styled-content> , 1.62–3.09). Defect‐free stroke care was also significantly associated with excellent outcome (modified Rankin Scale score 0–1) (odds ratio, 1.22; 95% <jats:styled-content style="fixed-case">CI</jats:styled-content> , 1.04–1.43). No hospital characteristic was independently predictive of outcome. Only 1445 (15%) of eligible patients with AIS received all processes of care, with significant regional variations in overall and individual rates. </jats:p> </jats:sec> <jats:sec xml:lang="en"> <jats:title>Conclusions</jats:title> <jats:p xml:lang="en"> Use of evidence‐based care is associated with improved clinical outcome in <jats:styled-content style="fixed-case">AIS</jats:styled-content> . Strategies are required to address regional variation in the use of proven <jats:styled-content style="fixed-case">AIS</jats:styled-content> treatments. </jats:p> </jats:sec> <jats:sec xml:lang="en"> <jats:title>Clinical Trial Registration</jats:title> <jats:p xml:lang="en"> <jats:styled-content style="fixed-case">URL</jats:styled-content> : <jats:ext-link xmlns:xlink="http://www.w3.org/1999/xlink" ext-link-type="uri" xlink:href="https://www.clinicaltrials.gov">https://www.clinicaltrials.gov</jats:ext-link> . Unique Identifier: <jats:styled-content style="fixed-case">NCT</jats:styled-content> 02162017. </jats:p> </jats:sec>
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