Patients Do Better at Hospitals That Follow Stroke Guidelines

Stroke patients taken to hospitals that follow specific treatment protocols may have a better chance of surviving than patients taken elsewhere, new research suggests.

The study looked at the first one million stroke patients treated at hospitals enrolled in the "Get With The Guidelines" stroke program, launched in 2003 by the American Heart Association and the American Stroke Association. It is published in Circulation: Cardiovascular Quality and Outcomes.

The guidelines require that hospitals follow seven specific steps for treating stroke patients, including administering clot-dissolving medications within three hours of the start of symptoms and antiplatelet medications (such as aspirin) in the first 48 hours.

Between 2003 and 2009, hospitals that followed the protocols lowered the risk of death by 10% for patients who had an ischemic stroke, the most common type, or a transient ischemic attack (TIA), considered a precursor to a full-blown stroke.

"There have been remarkable improvements in quality of care delivered and outcomes," says study author Gregg Fonarow, MD, a professor of cardiovascular medicine at University of California, Los Angeles. "For individuals having a stroke, coming to one of the 'Get With The Guidelines'-participating hospitals means there is a far greater likelihood they will receive evidence-based therapies that can reduce the risk of long-term disability, deaths, and recurrent events."

The recommended steps include:

• Giving clot-dissolving medication, or intravenous recombinant tissue plasminogen activator (tPA) three hours from the onset of symptoms for those with ischemic stroke.

• Giving anti-platelet or anticoagulant medication within 48 hours of admission and at discharge.

• Providing treatments to prevent deep vein thrombosis by the end of day two.

• Giving patients with atrial fibrillation anticoagulation medications such as Coumadin (warfarin) at discharge.

• Providing cholesterol-lowering medications such as statins to help prevent additional strokes or heart attacks.

• Provide smokers with information on smoking cessation.

Since 2003, nearly 1,400 hospitals of the nation's approximately 5,000 community hospitals have pledged to follow the protocols and enter their data into a national registry. Between 2003 and 2009, the percentage of stroke or TIA patients who received all of the recommended treatments increased from 44% to 84%, while those who received nearly all increased from 72% to 93%, the researchers reported.

Patients average age was about 72. About 60% had an ischemic stroke, nearly 23% had a TIA, nearly 11% had an intracerebral hemorrhage, 3.5% had a subarachnoid hemorrhage, and 2.7% of strokes were unclassified. Hospital mortality was highest among patients suffering hemorrhagic strokes, caused by blood leaking into the brain tissue.

Source: Brigham and Women's Hospital