TY - JOUR
T1 - US Surveillance of Acute Ischemic Stroke Patient Characteristics, Care Quality, and Outcomes for 2019
AU - Ziaeian, Boback
AU - Xu, Haolin
AU - Matsouaka, Roland A.
AU - Xian, Ying
AU - Khan, Yosef
AU - Schwamm, Lee S.
AU - Smith, Eric E.
AU - Fonarow, Gregg C.
N1 - Funding Information:
Dr Xian received research grant from the National Institute On Aging (R01AG062770 and R01AG066672), and Genentech. Dr Schwamm is a consultant from Boehringer Ingelheim and received research grants from NINDS, NIA, PCORI; serves on scientific advisory boards for (1) LifeImage (2) Medtronic clinical trial design for AF related stroke NCT02700945 (3) Penumbra MIND study DSMB NCT03342664, (4) Genentech TIMELESS study NCT03785678 Steering Committee, and expert advisory panel on late window thrombolysis, (5) Diffusion Pharma DSMB PHAST-TSC NCT03763929. Serves as volunteer chair of the AHA/ASA stroke systems of care advisory committee, and ASA Advisory Committee of the AHA Board of Directors (unpaid). Dr Fonarow performed research at American Heart Association, National Institutes of Health; and consulting at Abbott, Amgen, Bayer, Janssen, Medtronic, and Novartis.
Publisher Copyright:
© 2022 Lippincott Williams and Wilkins. All rights reserved.
PY - 2022/11/1
Y1 - 2022/11/1
N2 - Background: The United States lacks a timely and accurate nationwide surveillance system for acute ischemic stroke (AIS). We use the Get With The Guidelines-Stroke registry to apply poststratification survey weights to generate national assessment of AIS epidemiology, hospital care quality, and in-hospital outcomes. Methods: Clinical data from the Get With The Guidelines-Stroke registry were weighted using a Bayesian interpolation method anchored to observations from the national inpatient sample. To generate a US stroke forecast for 2019, we linearized time trend estimates from the national inpatient sample to project anticipated AIS hospital volume, distribution, and race/ethnicity characteristics for the year 2019. Primary measures of AIS epidemiology and clinical care included patient and hospital characteristics, stroke severity, vital and laboratory measures, treatment interventions, performance measures, disposition, and clinical outcomes at discharge. Results: We estimate 552 476 patients with AIS were admitted in 2019 to US hospitals. Median age was 71 (interquartile range, 60-81), 48.8% female. Atrial fibrillation was diagnosed in 22.6%, 30.2% had prior stroke/transient ischemic attack, and 36.4% had diabetes. At baseline, 46.4% of patients with AIS were taking antiplatelet agents, 19.2% anticoagulants, and 46.3% cholesterol-reducers. Mortality was 4.4%, and only 52.3% were able to ambulate independently at discharge. Performance nationally on AIS achievement measures were generally higher than 95% for all measures but the use of thrombolytics within 3 hours of early stroke presentations (81.9%). Additional quality measures had lower rates of receipt: dysphagia screening (84.9%), early thrombolytics by 4.5 hours (79.7%), and statin therapy (80.6%). Conclusions: We provide timely, reliable, and actionable US national AIS surveillance using Bayesian interpolation poststratification weights. These data may facilitate more targeted quality improvement efforts, resource allocation, and national policies to improve AIS care and outcomes.
AB - Background: The United States lacks a timely and accurate nationwide surveillance system for acute ischemic stroke (AIS). We use the Get With The Guidelines-Stroke registry to apply poststratification survey weights to generate national assessment of AIS epidemiology, hospital care quality, and in-hospital outcomes. Methods: Clinical data from the Get With The Guidelines-Stroke registry were weighted using a Bayesian interpolation method anchored to observations from the national inpatient sample. To generate a US stroke forecast for 2019, we linearized time trend estimates from the national inpatient sample to project anticipated AIS hospital volume, distribution, and race/ethnicity characteristics for the year 2019. Primary measures of AIS epidemiology and clinical care included patient and hospital characteristics, stroke severity, vital and laboratory measures, treatment interventions, performance measures, disposition, and clinical outcomes at discharge. Results: We estimate 552 476 patients with AIS were admitted in 2019 to US hospitals. Median age was 71 (interquartile range, 60-81), 48.8% female. Atrial fibrillation was diagnosed in 22.6%, 30.2% had prior stroke/transient ischemic attack, and 36.4% had diabetes. At baseline, 46.4% of patients with AIS were taking antiplatelet agents, 19.2% anticoagulants, and 46.3% cholesterol-reducers. Mortality was 4.4%, and only 52.3% were able to ambulate independently at discharge. Performance nationally on AIS achievement measures were generally higher than 95% for all measures but the use of thrombolytics within 3 hours of early stroke presentations (81.9%). Additional quality measures had lower rates of receipt: dysphagia screening (84.9%), early thrombolytics by 4.5 hours (79.7%), and statin therapy (80.6%). Conclusions: We provide timely, reliable, and actionable US national AIS surveillance using Bayesian interpolation poststratification weights. These data may facilitate more targeted quality improvement efforts, resource allocation, and national policies to improve AIS care and outcomes.
KW - Bayesian analysis
KW - epidemiology
KW - health services
KW - ischemic stroke
KW - quality and outcomes
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U2 - 10.1161/STROKEAHA.122.039098
DO - 10.1161/STROKEAHA.122.039098
M3 - Article
C2 - 35862201
AN - SCOPUS:85140658640
SN - 0039-2499
VL - 53
SP - 3386
EP - 3393
JO - Stroke
JF - Stroke
IS - 11
ER -