Clinical research studySecondary Prevention after Ischemic Stroke or Transient Ischemic Attack
Section snippets
Get With The Guidelines-Stroke (GWTG-Stroke) Program
The GWTG-Stroke program is a voluntary quality improvement program across the US, which collects information on stroke admission. The methods of the GWTG-Stroke program have been described previously.10, 11, 12 Briefly, for each hospitalization for stroke or transient ischemic attack, information on patient demographics, medical history, in-hospital diagnostic work-up, treatment, discharge medications, counseling, and disposition were collected using an Internet-based patient management tool
Results
Among the 1.4 million patients with stroke or transient ischemic attack, 858,835 patients with ischemic stroke or transient ischemic attack from 1545 sites fulfilled the inclusion criteria and were included in this analysis (Figure 1). Among them, 259,319 (30%) patients presented with a transient ischemic attack and 599,516 (70%) patients presented with an ischemic stroke.
Discussion
In this analysis of close to a million admissions for ischemic stroke or transient ischemic attack, adherence to evidence-based secondary prevention and other quality-of-care discharge measures were consistently lower (except for antihypertensives usage) for the transient ischemic attack cohort when compared with ischemic stroke cohort. In addition, although adherence to the secondary prevention and other quality-of-care measures increased with time (from 2007-2011), the magnitude of the
Study Limitations
Our data are from a prospective registry of patients from a voluntary quality-reporting program; therefore, adherence to guideline-recommended secondary prevention therapies may be higher in these hospitals than in hospitals not participating in GWTG-Stroke. If so, it is possible that the difference in quality of care between transient ischemic attack and ischemic stroke might be even greater in nonparticipating hospitals. However, this is still the largest series reporting secondary prevention
Conclusions
Data from over close to a million patients with ischemic stroke or transient ischemic attack suggest that the hospital adherence to evidence-based secondary prevention and other quality-of-care measures at the time of discharge is consistently lower for patients with transient ischemic attack when compared with patients with ischemic stroke. The adherence to these discharge measures has increased in GWTG-Stroke program from 2007 to 2011 but is still consistently lower for the transient ischemic
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Effects of long-term regular oral aspirin combined with atorvastatin to prevent ischemic stroke on human gut microbiota
2023, European Journal of PharmacologySecondary CV Prevention in South America in a Community Setting: The PURE Study
2017, Global HeartCitation Excerpt :Even in hospital-based settings, less than two-thirds of eligible ischemic stroke patients were discharged on all 3 guideline-recommended secondary preventive drugs [37]. Among 858,835 patients with TIA or ischemic stroke, adherence to secondary prevention measures was consistently lower for the TIA cohort [38], suggesting that higher risk patients are more likely to be effectively treated, as we have suggested based on our data. In <2 years, about one-quarter of TIA patients, from a community-based setting, became nonpersistent, which was associated with younger age (<55 years), and those nonpersistent users were less adherent to other preventive medication than persistent users were [39].
First hospitalization for transient ischemic attack in France: Characteristics, treatments and 3-year outcomes
2016, Revue NeurologiqueCitation Excerpt :Nevertheless, some of them may have their explorations before hospitalization or after discharge. The median length of stay in France is longer than that reported in the United States (4 days and 2 days, respectively), while the mean age of the patients was similar, around 69 years, with 45% of males in France versus 43% in the United States [13]. However, the French study exclusively concerned the first TIA.
Apparent treatment-resistant hypertension among individuals with history of stroke or transient ischemic attack
2015, American Journal of MedicineCitation Excerpt :Finally, restriction of analysis to those with treatment including a diuretic reduced the likelihood of black participants having apparent treatment-resistant hypertension, with the age–race–sex-adjusted PR decreasing from 1.62 (CI, 1.09-1.52) to 1.30 (CI, 1.10-1.54) and the multivariable adjusted PR decreasing from 1.34 (CI, 1.10-1.63) to 1.15 (CI, 0.94-1.39) (Supplementary Table 4, available online). Treatment and control of hypertension has long been recognized as among the most important goals in secondary stroke prevention.8,32-34 Our results suggest that the prevalence of apparent treatment-resistant hypertension is higher among those with TIA than their counterparts without a history of TIA/stroke and higher still among those with a history of stroke.
The reply
2015, American Journal of MedicineQuality of care: A long way to tipperary or a long way down
2015, American Journal of Medicine
Funding: The GWTG-Stroke program is provided by the AHA/American Stroke Association. The GWTG-Stroke program is currently supported in part by a charitable contribution from Janssen Pharmaceutical Companies of Johnson & Johnson. GWTG-Stroke has been funded in the past through support from Boehringer Ingelheim, Merck, Bristol-Myers Squib/Sanofi Pharmaceutical Partnership, and the AHA Pharmaceutical Roundtable. The industry sponsors of GWTG-Stroke had no role in the design and conduct of the study; in the collection, analysis, and interpretation of the data; or in the preparation, review, or approval of the manuscript.
Conflicts of Interest: SB, EES, IMS, and LL report no disclosures. LS reports the following: Serves as the unpaid chair of the AHA GWTG Stroke Clinical Working Group; serves as a Stroke Systems of Care Expert Consultant and measure development expert to the Joint Commission, Coverdell Registry/MA Dept of Public Health; is on the steering committee for the Medtronic Victory AF trial, and the DSMB for the NovoNordisk DEVOTE trial. He receives research funding from NINDS and PCORI. GCF reports the following: Employment—UCLA Employee, which holds a patent on stroke retriever devices National Institutes of Health—Grants and grants pending. DLB discloses the following relationships: Advisory Board, Elsevier; Practice Update Cardiology, Medscape Cardiology, Regado Biosciences; Board of Directors: Boston VA Research Institute, Society of Cardiovascular Patient Care; Chair: American Heart Association Get With The Guidelines Steering Committee; Data Monitoring Committees: Duke Clinical Research Institute; Harvard Clinical Research Institute; Mayo Clinic; Population Health Research Institute; Honoraria: American College of Cardiology (Editor, Clinical Trials, Cardiosource), Belvoir Publications (Editor in Chief, Harvard Heart Letter), Duke Clinical Research Institute (clinical trial steering committees), Harvard Clinical Research Institute (clinical trial steering committee), HMP Communications (Editor in Chief, Journal of Invasive Cardiology); Population Health Research Institute (clinical trial steering committee), Slack Publications (Chief Medical Editor, Cardiology Today’s Intervention), WebMD (CME steering committees); Other: Clinical Cardiology (Associate Editor); Journal of the American College of Cardiology (Section Editor, Pharmacology); Research Grants: Amarin, AstraZeneca, Bristol-Myers Squibb, Eisai, Ethicon, Medtronic, Roche, Sanofi Aventis, The Medicines Company; Unfunded Research: FlowCo, PLx Pharma, Takeda.
Authorship: All authors had access to the data and a role in writing the manuscript.