Abstract 5623: Early Antithrombotic Therapy Performance Measure in Ischemic Stroke and Clinical Outcomes
Background: Guidelines recommend that patients hospitalized with ischemic stroke should receive antithrombotic therapy within 48 hours of symptom onset to reduce stroke mortality and morbidity. An early antithrombotic process of care measure is being considered by the Center for Medicare and Medicaid Services (CMS). However, it is unknown if this process of care measure is associated with outcomes in routine clinical practice and provides discrimination of the quality of stroke care provided at the hospital level.
Methods: We analyzed data from 91,184 Medicare fee-for-service beneficiaries enrolled from 625 Get With The Guidelines-Stroke hospitals between April 2003 and December 2006, which were linked to outcome data from CMS. The process measure assessed was the % of patients with ischemic stroke who received antithrombotic (antiplatelet or anticoagulant) therapy by the end of hospital day two in the absence of IV tPA and as long as no contraindications existed. Cox proportional hazards models were used to estimate the unadjusted and adjusted association of this process measure with 30-day mortality.
Results: Mean age was 79.3 years, 58% were female, and 32% had prior stroke/TIA. The median hospital conformity rate was 93.8% (25th-75th, 90.3–96.7%) for this measure. The 30-day mortality rate (measured from hospital day 2) in this cohort was 13.1%. The adjusted odds ratio for 30-day mortality with a 10% increase in adherence at the hospital level was 0.91, 95% CI 0.87– 0.96, P=0.0005.
Conclusions: An early antithrombotic therapy performance measure in eligible ischemic stroke patients is associated with improved 30-day outcomes, discriminates quality of care for ischemic stroke, and may be considered a useful clinical performance measure.
This research has received full or partial funding support from the American Heart Association, National Center.