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Patterns of care quality and prognosis among hospitalized ischemic stroke patients with chronic kidney disease.

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Date
2014-06-05
Authors
Ovbiagele, Bruce
Schwamm, Lee H
Smith, Eric E
Grau-Sepulveda, Maria V
Saver, Jeffrey L
Bhatt, Deepak L
Hernandez, Adrian F
Peterson, Eric D
Fonarow, Gregg C
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Abstract
BACKGROUND: Relatively little is known about the quality of care and outcomes for hospitalized ischemic stroke patients with chronic kidney disease (CKD). We examined quality of care and in-hospital prognoses among patients with CKD in the Get With The Guidelines-Stroke (GWTG-Stroke) program METHODS AND RESULTS: We analyzed 679 827 patients hospitalized with ischemic stroke from 1564 US centers participating in the GWTG-Stroke program between January 2009 and December 2012. Use of 7 predefined ischemic stroke performance measures, composite "defect-free" care compliance, and in-hospital mortality were examined based on glomerular filtration rate (GFR) categorized as a dichotomous (+CKD as <60) or rank-ordered variable: normal (≥ 90), mild (≥ 60 to <90), moderate (≥ 30 to <60), severe (≥ 15 to <30), and kidney failure (<15 or dialysis). There were 236 662 (35%) ischemic stroke patients with CKD. Patients with severe renal dysfunction or failure were significantly less likely to receive guideline-based therapies. Compared with patients with normal kidney function (≥ 90), those with CKD (adjusted OR 0.91 [95% CI: 0.89 to 0.92]), moderate dysfunction (adjusted OR 0.94 [95% CI: 0.92 to 0.97]), severe dysfunction (adjusted OR 0.80 [95% CI: 0.77 to 0.84]), or failure (adjusted OR 0.72 [95% CI: 0.68 to 0.0.76]), were less likely to receive 100% defect-free care measure compliance. Inpatient mortality was higher for patients with CKD (adjusted odds ratio 1.44 [95% CI: 1.40 to 1.47]), and progressively rose with more severe renal dysfunction. CONCLUSIONS: Despite higher in-hospital mortality rates, ischemic stroke patients with CKD, especially those with greater severity of renal dysfunction, were less likely to receive important guideline-recommended therapies.
Type
Journal article
Subject
chronic kidney disease
glomerular Filtration Rate
guidelines
ischemic stroke
outcomes
prognosis
quality indicators
renal
Adolescent
Adult
Aged
Aged, 80 and over
Female
Glomerular Filtration Rate
Guideline Adherence
Hospital Mortality
Hospitals
Humans
Male
Middle Aged
Prognosis
Quality of Health Care
Renal Insufficiency, Chronic
Stroke
United States
Young Adult
Permalink
https://hdl.handle.net/10161/15010
Published Version (Please cite this version)
10.1161/JAHA.114.000905
Publication Info
Ovbiagele, Bruce; Schwamm, Lee H; Smith, Eric E; Grau-Sepulveda, Maria V; Saver, Jeffrey L; Bhatt, Deepak L; ... Fonarow, Gregg C (2014). Patterns of care quality and prognosis among hospitalized ischemic stroke patients with chronic kidney disease. J Am Heart Assoc, 3(3). pp. e000905. 10.1161/JAHA.114.000905. Retrieved from https://hdl.handle.net/10161/15010.
This is constructed from limited available data and may be imprecise. To cite this article, please review & use the official citation provided by the journal.
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Scholars@Duke

Hernandez

Adrian Felipe Hernandez

Duke Health Cardiology Professor
Peterson

Eric David Peterson

Fred Cobb, M.D. Distinguished Professor of Medicine
Dr Peterson is the Fred Cobb Distinguished Professor of Medicine in the Division of Cardiology, a DukeMed Scholar, and the Past Executive Director of the Duke Clinical Research Institute (DCRI), Durham, NC, USA. Dr Peterson is the Principal Investigator of the National Institute of Health, Lung and Blood Institute (NHLBI) Spironolactone Initiation Registry Randomized Interventional Trial in Heart Failure With Preserved Ejection Fraction (SPIRRIT) Trial  He is also the Principal I
This author no longer has a Scholars@Duke profile, so the information shown here reflects their Duke status at the time this item was deposited.
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