TY - JOUR
T1 - International comparison of patient characteristics and quality of care for ischemic stroke
T2 - Analysis of the China National Stroke Registry and the American Heart Association get with the guidelines—Stroke program
AU - Wangqin, Runqi
AU - Laskowitz, Daniel T.
AU - Wang, Yongjun
AU - Li, Zixiao
AU - Wang, Yilong
AU - Liu, Liping
AU - Liang, Li
AU - Matsouaka, Roland A.
AU - Saver, Jeffrey L.
AU - Fonarow, Gregg C.
AU - Bhatt, Deepak L.
AU - Smith, Eric E.
AU - Schwamm, Lee H.
AU - Bettger, Janet Prvu
AU - Hernandez, Adrian F.
AU - Peterson, Eric D.
AU - Xian, Ying
N1 - Funding Information:
Dr Saver serves as a consultant for Medtronic and Neuravi and is supported by a grant from Medtronic. Dr Fonarow reports research funding from Patient-Centered Outcomes Research Institute (PCORI) and is a steering committee member of GWTG. Dr Bhatt discloses the following relationships—Advisory Board: Cardax, Elsevier PracticeUpdate Cardiology, Medscape Cardiology, and Regado Biosciences; Board of Directors: Boston VA Research Institute, Society of Cardiovascular Patient Care, and TobeSoft; Chair: American Heart Association Quality Oversight Committee; Data Monitoring Committees: Baim Institute for Clinical Research (formerly Harvard Clinical Research Institute, for the PORTICO trial, funded by St. Jude Medical, now Abbott), Cleveland Clinic, Duke Clinical Research Institute, Mayo Clinic, Mount Sinai School of Medicine (for the ENVISAGE trial, funded by Daiichi Sankyo), and Population Health Research Institute; honoraria: American College of Cardiology (Senior Associate Editor, Clinical Trials and News, ACC.org; Vice-Chair, ACC Accreditation Committee), Baim Institute for Clinical Research (formerly Harvard Clinical Research Institute; RE-DUAL PCI [Randomized Evaluation of Dual Antithrombotic Therapy With Dabigatran versus Triple Therapy With Warfarin in Patients with Nonvalvular Atrial Fibrillation Undergoing Percutaneous Coronary Intervention] clinical trial steering committee funded by Boehringer Ingelheim), Belvoir Publications (Editor-in-Chief, Harvard Heart Letter), Duke Clinical Research Institute (clinical trial steering committees), HMP Global (Editor-in-Chief, Journal of Invasive Cardiology), Journal of the American College of Cardiology (Guest Editor; Associate Editor), Population Health Research Institute (for the COMPASS operations committee, publications committee, steering committee, and USA national co-leader, funded by Bayer), Slack Publications (Chief Medical Editor, Cardiology Today’s Intervention), Society of Cardiovascular Patient Care (Secretary/Treasurer), WebMD (CME steering committees); Other: Clinical Cardiology (Deputy Editor), NCDR-ACTION Registry Steering Committee (Chair), VA CART Research and Publications Committee (Chair); Research Funding: Abbott, Amarin, Amgen, AstraZeneca, Bayer, Boehringer Ingelheim, Bristol-Myers Squibb, Chiesi, Eisai, Ethicon, Forest Laboratories, Idorsia, Ironwood, Ischemix, Lilly, Medtronic, PhaseBio, Pfizer, Regeneron, Roche, Sanofi Aventis, Synaptic, and The Medicines Company; Royalties: Elsevier (Editor, Cardiovascular Intervention: A Companion to Braunwald’s Heart Disease); Site Co-Investigator: Biotronik, Boston Scientific, St. Jude Medical (now Abbott), Svelte; Trustee: American College of Cardiology; Unfunded Research: FlowCo, Merck, DLB PLx Pharma, Takeda. Dr Schwamm reported serving as the volunteer chair of the American Heart Association/American Stroke Association GWTG-Stroke Clinical Work Group. Dr Hernandez reports receipt of grant support from Amgen, AstraZeneca, Bayer, Bristol-Myers Squibb, GlaxoSmithKline, Luitpold, Merck, and Novartis; and personal fees from Amgen, AstraZeneca, Bayer, Bristol-Myers Squibb, Boston Scientific, Luitpold, and Novartis outside the submitted work. Dr Peterson reported receiving grants and/or personal fees from Bayer Pharmaceuticals, Janssen Pharmaceuticals, AstraZeneca, Genentech, and the American Heart Association GWTG-Stroke Analytic and has served as a consultant/advisory board member for Janssen, Boehringer Ingelheim, Sanofi, Bayer, Merck, AstraZeneca, Signal Path, and Venable. The remaining authors have no disclosures to report.
Funding Information:
Johnson & Johnson. GWTG-Stroke has been funded in the past through support from Boehringer Ingelheim, Merck, Bristol-Myers Squibb/Sanofi Pharmaceutical Partnership, and the AHA Pharmaceutical Roundtable.
Funding Information:
This study was supported, in part, by grants from the Ministry of Science and Technology and the Ministry of Health of the People’s Republic of China (National Key R&D Program of China: 2017YFC1310901, 2011BAI08B02, 2012ZX09303, 2013BAI 09B14, 2013BAI09B03, 2015BAI12B02, 2015BAI12B04, 2016YFC0 901000, 2016YFC0901002, 2017YFC1310900, 2017YFC1310903, and 2017YFC1307905), the National Key Technology Research and Development Program of the Ministry of Science and Technology of China (2013BAI09B03), Beijing Municipal Committee of Science and Technology (D15110700200000, D151100002015001, D15110000 2015002, Z161100000516223, and Z141107 002514125), and Beijing Institute for Brain Disorders (BIBD-PXM2013_014226_07_000084). This study was supported, in part, by a grant from the National Institutes of Health, US Department of Health and Human Services (1D43-TW008308). The GWTG-Stroke program is supported, in part, by a charitable contribution from Janssen Pharmaceutical Companies of Johnson & Johnson. GWTG-Stroke has been funded in the past through support from Boehringer Ingelheim, Merck, Bristol-Myers Squibb/Sanofi Pharmaceutical Partnership, and the AHA Pharmaceutical Roundtable.
Funding Information:
This study was supported, in part, by grants from the Ministry of Science and Technology and the Ministry of Health of the People’s Republic of China (National Key R&D Program of China: 2017YFC1310901, 2011BAI08B02, 2012ZX09303, 2013BAI 09B14, 2013BAI09B03, 2015BAI12B02, 2015BAI12B04, 2016YFC0 901000, 2016YFC0901002, 2017YFC1310900, 2017YFC1310903, and 2017YFC1307905), the National Key Technology Research and Development Program of the Ministry of Science and Technology of China (2013BAI09B03), Beijing Municipal Committee of Science and Technology (D15110700200000, D151100002015001, D15110000 2015002, Z161100000516223, and Z141107 002514125), and Beijing Institute for Brain Disorders (BIBD-PXM2013_014226_07_000084). This study was supported, in part, by a grant from the National Institutes of Health, US Department of Health and Human Services (1D43-TW008308). The GWTG-Stroke program is supported, in part, by a charitable contribution from Janssen Pharmaceutical Companies of
Publisher Copyright:
© 2018 The Authors.
PY - 2018/10/1
Y1 - 2018/10/1
N2 - Background-—Adherence to evidence-based guidelines is an important quality indicator; yet, there is lack of assessment of adherence to performance measures in acute ischemic stroke for most world regions. Methods and Results-—We analyzed 19 604 patients with acute ischemic stroke in the China National Stroke Registry and 194 876 patients in the Get With The Guidelines––Stroke registry in the United States from June 2012 to January 2013. Compared with their US counterparts, Chinese patients were younger, had a lower prevalence of comorbidities, and had similar median, lower mean, and less variability in National Institutes of Health Stroke Scale (median 4 [25th percentile–75th percentile, 2–7], mean 5.4±5.6 versus median 4 [1–10], mean 6.8±7.7). Chinese patients were more likely to experience delays from last known well to hospital arrival (median 1318 [330–3209] versus 644 [142–2055] minutes), less likely to receive thrombolytic therapy (2.5% versus 8.1%), and more likely to experience treatment delays (door-to-needle time median 95 [72–112] versus 62 [49–85] minutes). Adherence to early and discharge antithrombotics, smoking cessation counseling, and dysphagia screening were relatively high (eg >80%) in both countries. Large gaps existed between China and the United States with regard to the administration of thrombolytics within 3 hours (18.3% versus 83.6%), door-to-needle time ≤60 minutes (14.6% versus 48.0%), deep venous thrombosis prophylaxis (65.0% versus 97.8%), anticoagulation for atrial fibrillation (21.0% versus 94.4%), lipid treatment (66.3% versus 95.8%), and rehabilitation assessment (58.8% versus 97.4%). Conclusions-—We found significant differences in clinical characteristics and gaps in adherence for certain performance measures between China and the United States. Additional efforts are needed for continued improvements in acute stroke care and secondary prevention in both nations, especially China.
AB - Background-—Adherence to evidence-based guidelines is an important quality indicator; yet, there is lack of assessment of adherence to performance measures in acute ischemic stroke for most world regions. Methods and Results-—We analyzed 19 604 patients with acute ischemic stroke in the China National Stroke Registry and 194 876 patients in the Get With The Guidelines––Stroke registry in the United States from June 2012 to January 2013. Compared with their US counterparts, Chinese patients were younger, had a lower prevalence of comorbidities, and had similar median, lower mean, and less variability in National Institutes of Health Stroke Scale (median 4 [25th percentile–75th percentile, 2–7], mean 5.4±5.6 versus median 4 [1–10], mean 6.8±7.7). Chinese patients were more likely to experience delays from last known well to hospital arrival (median 1318 [330–3209] versus 644 [142–2055] minutes), less likely to receive thrombolytic therapy (2.5% versus 8.1%), and more likely to experience treatment delays (door-to-needle time median 95 [72–112] versus 62 [49–85] minutes). Adherence to early and discharge antithrombotics, smoking cessation counseling, and dysphagia screening were relatively high (eg >80%) in both countries. Large gaps existed between China and the United States with regard to the administration of thrombolytics within 3 hours (18.3% versus 83.6%), door-to-needle time ≤60 minutes (14.6% versus 48.0%), deep venous thrombosis prophylaxis (65.0% versus 97.8%), anticoagulation for atrial fibrillation (21.0% versus 94.4%), lipid treatment (66.3% versus 95.8%), and rehabilitation assessment (58.8% versus 97.4%). Conclusions-—We found significant differences in clinical characteristics and gaps in adherence for certain performance measures between China and the United States. Additional efforts are needed for continued improvements in acute stroke care and secondary prevention in both nations, especially China.
KW - International comparison
KW - Patient characteristics
KW - Performance measures
KW - Quality of care
KW - Stroke
UR - http://www.scopus.com/inward/record.url?scp=85055618685&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85055618685&partnerID=8YFLogxK
U2 - 10.1161/JAHA.118.010623
DO - 10.1161/JAHA.118.010623
M3 - Article
C2 - 30371291
AN - SCOPUS:85055618685
SN - 2047-9980
VL - 7
JO - Journal of the American Heart Association
JF - Journal of the American Heart Association
IS - 20
M1 - e010623
ER -