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International Comparison of Patient Characteristics and Quality of Care for Ischemic Stroke: Analysis of the China National Stroke Registry and the American Heart Association Get With The Guidelines--Stroke Program.

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Date
2018-10
Authors
Wangqin, Runqi
Laskowitz, Daniel T
Wang, Yongjun
Li, Zixiao
Wang, Yilong
Liu, Liping
Liang, Li
Matsouaka, Roland A
Saver, Jeffrey L
Fonarow, Gregg C
Bhatt, Deepak L
Smith, Eric E
Schwamm, Lee H
Prvu Bettger, Janet
Hernandez, Adrian F
Peterson, Eric D
Xian, Ying
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(17 total)
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Abstract
Background Adherence to evidence-based guidelines is an important quality indicator; yet, there is lack of assessment of adherence to performance measures in acute ischemic stroke for most world regions. Methods and Results We analyzed 19 604 patients with acute ischemic stroke in the China National Stroke Registry and 194 876 patients in the Get With The Guidelines--Stroke registry in the United States from June 2012 to January 2013. Compared with their US counterparts, Chinese patients were younger, had a lower prevalence of comorbidities, and had similar median, lower mean, and less variability in National Institutes of Health Stroke Scale (median 4 [25th percentile-75th percentile, 2-7], mean 5.4±5.6 versus median 4 [1-10], mean 6.8±7.7). Chinese patients were more likely to experience delays from last known well to hospital arrival (median 1318 [330-3209] versus 644 [142-2055] minutes), less likely to receive thrombolytic therapy (2.5% versus 8.1%), and more likely to experience treatment delays (door-to-needle time median 95 [72-112] versus 62 [49-85] minutes). Adherence to early and discharge antithrombotics, smoking cessation counseling, and dysphagia screening were relatively high (eg >80%) in both countries. Large gaps existed between China and the United States with regard to the administration of thrombolytics within 3 hours (18.3% versus 83.6%), door-to-needle time ≤60 minutes (14.6% versus 48.0%), deep venous thrombosis prophylaxis (65.0% versus 97.8%), anticoagulation for atrial fibrillation (21.0% versus 94.4%), lipid treatment (66.3% versus 95.8%), and rehabilitation assessment (58.8% versus 97.4%). Conclusions We found significant differences in clinical characteristics and gaps in adherence for certain performance measures between China and the United States. Additional efforts are needed for continued improvements in acute stroke care and secondary prevention in both nations, especially China.
Type
Journal article
Subject
Humans
Brain Ischemia
Age Distribution
Aged
Middle Aged
Quality of Health Care
Guideline Adherence
United States
China
Female
Male
Practice Guidelines as Topic
Stroke
Quality Improvement
Permalink
https://hdl.handle.net/10161/21636
Published Version (Please cite this version)
10.1161/jaha.118.010623
Publication Info
Wangqin, Runqi; Laskowitz, Daniel T; Wang, Yongjun; Li, Zixiao; Wang, Yilong; Liu, Liping; ... Xian, Ying (2018). International Comparison of Patient Characteristics and Quality of Care for Ischemic Stroke: Analysis of the China National Stroke Registry and the American Heart Association Get With The Guidelines--Stroke Program. Journal of the American Heart Association, 7(20). pp. e010623. 10.1161/jaha.118.010623. Retrieved from https://hdl.handle.net/10161/21636.
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

Professor of Medicine
Laskowitz

Daniel Todd Laskowitz

Professor of Neurology
Our laboratory uses molecular biology, cell culture, and animal modeling techniques to examine the CNS response to acute injury. In particular, our laboratory examines the role of microglial activation and the endogenous CNS inflammatory response in exacerbating secondary injury following acute brain insult. Much of the in vitro work in this laboratory is dedicated to elucidating cellular responses to injury with the ultimate goal of exploring new therapeutic interventions in the clinical settin
Matsouaka

Roland Albert Matsouaka

Assistant Professor of Biostatistics & Bioinformatics
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.
Xian

Ying Xian

Associate Professor in Neurology
Dr. Xian is an Associate Professor of Neurology and Medicine at the Duke University Medical Center and Duke Clinical Research Institute. He received his Medical Degree from Beijing Medical University (Peking University Health Science Center) and completed an Internal Medicine Residency and Cardiology Fellowship at Peking University People’s Hospital, and Fuwai Hospital, Peking Union Medical College. Dr. Xian’s research is dedicated to improving health care quality and outcomes in
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