New research, published this month in the journal Stroke, has demonstrated the key role quality improvement programmes play in ensuring hospitals can adequately tackle the public health threat of stroke in the USA.
The research in question indicates that ‘Get With The Guidelines-Stroke’—an in-hospital programme intended to improve stroke care by promoting consistent adherence to the latest scientific treatment guidelines—has become an “integral part” of stroke clinical practice and research across the country. That is according to a recent press release from the American Heart Association/American Stroke Association (AHA/ASA).
The release notes that close to eight million stroke cases from more than 2,800 hospitals have been entered into the registry, capturing about three-quarters of US stroke hospitalisations.
The study now published in Stroke reports substantial and sustained improvements in acute stroke care among those patients in the quality improvement programme. The researchers reviewed two decades’ worth of data, evaluating a registry-based, retrospective, observational cohort of all stroke/transient ischaemic attack (TIA) admissions at hospitals participating in the programme between April 2003 and December 2022. This cohort had a median age of 71 years, with 51% of patients self-identifying as female.
Examining patient characteristics, adherence to performance measures and in-hospital outcomes in patients hospitalised for acute ischaemic stroke, subarachnoid/intracerebral haemorrhage or TIA—and quantifying temporal changes in performance measure adherence and clinical outcomes over time—the researchers found that increased adherence to evidence-based stroke care translates to better clinical outcomes and, ultimately, more patients being discharged home or to a skilled nursing facility more quickly.
The AHA/ASA release states that, due to the relevance of the speed of stroke intervention, the time it takes to provide ischaemic stroke patients with thrombolytic therapy to dissolve their blood clots via medication—also known as ‘door-to-needle (DTN) time’—is now considered a standard marker.
In conjunction with the AHA/ASA ‘Target: Stroke’ programme, DTN times of less than one hour nearly quadrupled throughout the study period, and improvements in DTN times lower than 45 minutes were even greater, increasing eightfold. Similar improvements were also observed regarding mechanical thrombectomy procedures, commonly referred to as endovascular therapy (EVT).
“This is particularly relevant in the context of stroke care, where the goal is not only to save lives but also to restore function and maintain quality of life,” said Gregg Fonarow (University of California Los Angeles [UCLA], Los Angeles, USA), AHA volunteer and lead author of the study. “Stroke is an exquisitely time-sensitive disease, and Get With The Guidelines promotes delivery of evidence-based acute stroke care in a timely fashion, which in turn improves patient-centred clinical outcomes.”
Overall, the positive trends observed in the study suggest that concerted quality improvement initiatives can improve stroke care delivery and patient outcomes across diverse populations and locales, the authors believe.
The AHA/ASA launched Get With The Guidelines-Stroke in 2003, with early results demonstrating that its implementation was associated with improvements in acute stroke care and secondary prevention. And, since the launch of the stroke programme, Get With The Guidelines quality improvement modules have been added to cover atrial fibrillation, coronary artery disease, heart failure and resuscitation, with each promoting consistent adherence to the latest research-driven guidelines and measurements while providing data and information to professionals to facilitate continual improvement in patient care.
All Get With The Guidelines modules are associated with significant improvements in multiple processes of care strongly linked to better outcomes, as claimed in the AHA/ASA’s recent release.
