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.
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 articleSubject
HumansBrain Ischemia
Age Distribution
Aged
Middle Aged
Quality of Health Care
Guideline Adherence
United States
China
Female
Male
Practice Guidelines as Topic
Stroke
Quality Improvement
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https://hdl.handle.net/10161/21636Published Version (Please cite this version)
10.1161/jaha.118.010623Publication 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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Show full item recordScholars@Duke
Adrian Felipe Hernandez
Professor of Medicine
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
Roland Albert Matsouaka
Assistant Professor of Biostatistics & Bioinformatics
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.
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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