Chinese stroke patients fare better when hospitals follow guidelines

Chinese stroke patients were less likely to acquire pneumonia or die from the stroke when hospitals followed treatment guidelines, according to research presented at the American Heart Association's Quality of Care and Outcomes Research Scientific Sessions 2014.

Closer adherence to the American Heart Association/American Stroke Association's Get With The Guidelines®-Stroke led to a drop in pneumonia from 20 percent to almost 5 percent.

However, only 55.5 percent of patients received all guideline-recommended treatments for which they were eligible.

Developed with the goal to save lives and hasten recovery, Get With The Guidelines programs have touched the lives of nearly 5 million patients since 2001. Studies show that consistent application of these programs can lead to better recoveries and lower risks of ending up back in the hospital.

"In China, stroke is the major cause of death and long-term disability and improving the quality of stroke care is a national priority," said Zixiao Li, M.D., the study's lead author and a neurologist at Capital Medical University's teaching hospital in Beijing, Beijing Tiantan Hospital. "Practitioners should make efforts to increase adherence to all stroke performance measures."

Researchers looked at 24,597 stroke patients in 221 Chinese hospitals from January 2012-February 2013. They found that:

• The quarter of patients whose treatment program had the lowest adherence to stroke performance measures had a death rate of 4.8 percent, compared to 0.4 percent among the quarter of patients whose treatment program had the highest adherence rate.
• When the number of interventions performed on eligible patients was divided by the total possible number of appropriate treatments, the composite measure was 82 percent. A higher composite measure was linked to lower rate of in-hospital death and pneumonia.
• Fewer than 14 percent of ischemic stroke patients received the clot-busting drug tPA, which can improve blood flow to the brain and improve the chances of recovering from an ischemic stroke if given within three hours of the onset of stroke symptoms.
• More than 96 percent of all patients were treated quickly with antithrombotics (such as aspirin, clopidogrel or Aggrenox) to help prevent blood clots.

Several factors contribute to the low rate of tPA use, Li said:

• Not recognizing stroke symptoms, waiting too long to seek care or arriving too late for tPA use
• Not calling for emergency medical services unless the stroke was severe
• Delays in laboratory testing
• Patients and their families' knowledge rate of tPA is relatively low
• High medication costs