American Heart Association

FOR RELEASE:
2 p.m. EST, Thursday
Feb. 16, 2006

CONTACT:
For information Feb. 16-18 call:
Bridgette McNeill, Carole Bullock, or
Julie Del Barto (broadcast)
at the Gaylord Palms, Kissimmee, Fla.
(407) 586-2901

Abstract 23

American Stroke Association meeting report:
Hospitals improve stroke care with guideline-driven approach
KISSIMMEE, Fla., Feb. 16 – Hospitals that used a stroke intervention program improved in several key stroke care areas and maintained those results through two years, according to data presented today at the American Stroke Association’s International Stroke Conference 2006.

Get With The Guidelines–Stroke (GWTG-Stroke) — the American Stroke Association’s voluntary hospital-based quality improvement program — focuses on key interventions that reduce complications and prolong life after stroke. The interventions are:

Using the clot-busting drug intravenous tissue plasminogen activator (tPA) within three hours after stroke symptom onset,
Administering antithrombotics, such as aspirin, within 48 hours of stroke onset,
Preventing deep vein thrombosis within the first 48 hours,
Prescribing antithrombotics at discharge,
Prescribing anticoagulation therapy for atrial fibrillation (a type of irregular heartbeat),
Treating high cholesterol at discharge,
Counseling for smoking cessation at discharge,
Treating diabetes at discharge, and
Counseling for lifestyle changes in obese patients.

To determine how implementing GWTG–Stroke affected patient care in the acute care setting, researchers analyzed the care of 37,753 patients treated for stroke at 65 U.S. hospitals that have been using the program for two consecutive years. They assessed key performance measures before the intervention started and every quarter for two years after launching GWTG–Stroke.

“Our findings challenge the conventional wisdom that hospitals should focus on one intervention at a time,” said Lee H. Schwamm, M.D., lead author of the study and director of TeleStroke and Acute Stroke Services at Massachusetts General Hospital in Boston. “Using our guidelines, hospitals improved in several domains simultaneously. While a lot of improvement efforts wane after the first year, this program showed sustained improvement over two years.”

Schwamm said the program helped hospitals improve not only in the primary focus areas listed above, but also in collateral areas such as diabetes and obesity management.

Hospitals in the sample at baseline were administering the clot buster tPA to 27.6 percent of eligible patients who had arrived at the emergency room within two hours of stroke onset. That’s the ideal time to arrive at the emergency department, Schwamm said, because it gives staff time to evaluate patients and administer the therapy before the three-hour tPA eligibility cutoff. The drug is only approved to be given within three hours of symptom onset and has been shown to reduce permanent disability. At the end of one year in GWTG-Stroke, the number of patients receiving intravenous tPA had risen to 51 percent and remained there over the following second year.

Doubling the number of eligible people who received the therapy was a highly significant improvement. But Schwamm said still only half of those eligible are getting the drug that helps reduce disability after stroke. Though the rate of eligible treatment rose consistently throughout the eight quarters the rate of complications from the increased use of intravenous tPA didn’t rise. “There was concern that the rate of complications would go up because of the increased use of the drug in the community hospital setting. But there’s no evidence that risk is increased when tPA is used more broadly in these hospitals,” Schwamm said.

In other measures, researchers documented an absolute percentage change of:

8.4 percent improvement from baseline to two years in people receiving antithrombotics in the first 48 hours,
5.4 percent improvement in eligible patients receiving antithrombotic prescriptions at discharge,
18.2 percent improvement in eligible patients getting anticoagulation therapy for atrial fibrillation at discharge,
25 percent improvement in the number of people receiving medication for managing cholesterol,
37.7 percent improvement in the number of smokers who received smoking cessation counseling,
40.8 percent improvement in the number of eligible people getting medication for diabetes, and
12.5 percent improvement in lifestyle counseling including weight loss and physical activity.

The only decline was a 6.2 percent reduction in the use of deep vein thrombosis prevention which Schwamm attributed to an increase in the awareness of the disease and improved detection of patients at risk.

“There is clear evidence that hospitals should adhere to these quality improvement measures and there are clear practice guidelines on how to do it,” Schwamm said. “If you initiate a structured quality improvement program based on those principles, there will be improvements in care.”

Studies have shown that when people are started on these therapies while in the hospital, they are more likely to be on the interventions a year after discharge.

“These therapies translate into a reduced risk of stroke and heart attack and may prevent complications,” Schwamm said. “Next, we need to help patients do a better job of staying on these treatments after hospital discharge, so they can fully reap the benefits.”

Co-authors are Kenneth A. LaBresh, M.D.; Wenqin Pan, Ph.D. and Michael Frankel, M.D. on behalf of the GWTG Steering Committee and Investigators.

GWTG–Stroke is supported by an unrestricted educational grant from Merck & Co., Inc. and the Merck/Schering-Plough Pharmaceutical Partnership.

Editor’s note: For more information on the American Heart Association’s Get WithThe Guidelines (GWTG) programs visit Americanheart.org/getwiththeguidelines.

Statements and conclusions of study authors that are published in the American Heart Association scientific journals are solely those of the study authors and do not necessarily reflect association policy or position. The American Heart Association makes no representation or warranty as to their accuracy or reliability.

NR06-1017 (ISC06/Schwamm)

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