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(Circulation. 2009;119:107-115.)
© 2009 American Heart Association, Inc.

Stroke

Get With the Guidelines–Stroke Is Associated With Sustained Improvement in Care for Patients Hospitalized With Acute Stroke or Transient Ischemic Attack

Lee H. Schwamm, MD; Gregg C. Fonarow, MD; Mathew J. Reeves, PhD; Wenqin Pan, PhD; Michael R. Frankel, MD; Eric E. Smith, MD, MPH; Gray Ellrodt, MD; Christopher P. Cannon, MD; Li Liang, PhD; Eric Peterson, MD, MPH; Kenneth A. LaBresh, MD

From the Massachusetts General Hospital, Boston (L.H.S., E.E.S.); UCLA Medical Center, Los Angeles, Calif (G.C.F.); Michigan State University, East Lansing (M.J.R.); Duke Clinical Research Institute, Durham, NC (W.P., L.L., E.P.); Emory University, Atlanta, Ga (M.R.F.); Berkshire Medical Center, Pittsfield, Mass (G.E.); Brigham and Women’s Hospital, Boston, Mass (C.P.C.); and Masspro, Waltham, Mass (K.A.L.).

Correspondence to Lee H. Schwamm, MD, Vice Chairman of Neurology, ACC720, Massachusetts General Hospital, 55 Fruit St, Boston, MA 02114. E-mail lschwamm{at}partners.org

Received April 2, 2008; accepted September 16, 2008.

Background— Adherence to evidence-based guidelines for treatment of stroke or transient ischemic attack is suboptimal. We sought to establish whether participation in Get With the Guidelines–Stroke was associated with improvements in adherence.

Methods and Results— This prospective, nonrandomized, national quality improvement program measured adherence to guideline recommendations in 322 847 hospitalized patients discharged with a diagnosis of ischemic stroke or transient ischemic attack. A volunteer sample of 790 US academic and community hospitals participated from 2003 through 2007. The main outcome measures were change in adherence over time to 7 prespecified performance measures and a composite measure (total number of interventions provided in eligible patients divided by total number of care opportunities among eligible patients). Generalized estimating equations were used to identify factors associated with improvement. Participation in Get With the Guidelines–Stroke was associated with improvements in the 7 individual and 1 composite measures from baseline to the fifth year: intravenous thrombolytics (42.09% versus 72.84%), early antithrombotics (91.46% versus 97.04%), deep vein thrombosis prophylaxis (73.79% versus 89.54%), discharge antithrombotics (95.68% versus 98.88%), anticoagulation for atrial fibrillation (95.03% versus 98.39%), lipid treatment for low-density lipoprotein >100 mg/dL (73.63% versus 88.29%), smoking cessation (65.21% versus 93.61%), and composite (83.52% versus 93.97%) (P<0.0001 for all comparisons). Multivariate analysis showed that time in Get With the Guidelines–Stroke was associated with a 1.18-fold yearly increase in the odds of fulfilling care opportunities that was independent of secular trends.

Conclusions— Get With the Guidelines–Stroke participation was associated with increased adherence to all stroke performance measures. Markedly improved stroke care was seen in all hospitals regardless of size, geography, and teaching status.

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