Abstract 1293: Antithrombotic Therapy at Hospital Discharge Performance Measure in Ischemic Stroke and Clinical Outcomes
Background: Guidelines recommend that patients hospitalized with ischemic stroke should be prescribed antithrombotic therapy at discharge to reduce recurrent stroke risk. Antithrombotic therapy at discharge is being considered as a process of care measure by the Center for Medicare Services (CMS). However, it is unknown if this process of care measure is associated with outcomes in actual 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 at hospital discharge in the absence of contraindications. Log rank and Cox proportional hazards models were used to estimate the unadjusted and adjusted association of this hospital-level process measure with 90-day mortality, 90-day death/rehospitalization, and 90-day rehospitalization.
Results: Mean age in this cohort was 79.3 years, 58% were female, and 32% had prior stroke/TIA. The median hospital conformity rate was 94.1% (25th–75th, 90.6–96.7%) for this measure. The 90-day mortality rate (measured from hospital discharge) in this cohort was 15.3%, 90-day rehospitalization rate 26.8%, and 90-day death/rehospitalization rate 27.3%. The adjusted odds ratio for 90-day mortality for each 10% increase in adherence at the hospital level was 0.946, 95% CI 0.898– 0.997, P=0.038.
Conclusions: An antithrombotic therapy at discharge performance measure in eligible ischemic stroke patients is associated with improved 90-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.