Tuesday 21 Oct 2014

Information and opinions presented here do not always represent the views of the American Heart Association.

Chinese stroke patients recover better when hospitals follow guidelines

Published: 1:55 pm CDT, June 3, 2014

Chinese stroke patients are less likely to get pneumonia or die when hospitals follow treatment guidelines, according to research presented at the American Heart Association’s Quality of Care and Outcomes Research Scientific Sessions 2014.

Closer adherence to the American Heart Association/American Stroke Association’s Get With The Guidelines-Stroke program led to a drop in pneumonia from 20 percent to almost 5 percent.

However, only 55.5 percent of patients received all guideline-recommended treatments they were eligible for.

Studies show that the consistent use of quality improvement programs like Get With The Guidelines can lead to better recovery and lower risks of ending up back in the hospital.

“In China, stroke is the major cause of death and long-term disability and improving the quality of stroke care is a national priority,” said Zixiao Li, M.D., the study’s lead author and a neurologist at Capital Medical University’s teaching hospital in Beijing, Beijing Tiantan Hospital. “Practitioners should make efforts to increase adherence to all stroke performance measures.”

Researchers looked at 24,597 stroke patients in 221 Chinese hospitals from January 2012-February 2013 and found:

  • Death rates were 4.8 percent for the quarter of patients whose treatment had the lowest adherence to stroke performance measures versus 0.4 percent for the quarter with the highest adherence rate.
  • When the number of interventions performed on eligible patients was divided by the total possible number of appropriate treatments, the composite measure was 82 percent. A higher composite measure was linked to lower rate of in-hospital death and pneumonia.
  • Less than 14 percent of ischemic stroke patients received tPA, the clot-busting drug that can improve blood flow to the brain and recovery if given within three hours of the start of stroke symptoms.
  • More than 96 percent of all patients were treated quickly with drugs such as aspirin, clopidogrel or Aggrenox to help prevent blood clots.

Several factors contribute to the low rate of tPA use, including not recognizing stroke symptoms, waiting to long to get care or arriving at the hospital too late to get the drug, Li said. Other factors include not calling emergency medical services unless a stroke was severe, delayed laboratory testing, a lack of knowledge among patients and families about tPA and high medication costs.

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