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Impact of Evidence-Based Stroke Care on Patient Outcomes: A Multilevel Analysis of an International Study.pdf (1.3 MB)

Impact of Evidence-Based Stroke Care on Patient Outcomes: A Multilevel Analysis of an International Study.

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posted on 2019-08-14, 16:13 authored by P Muñoz Venturelli, X Li, S Middleton, C Watkins, PM Lavados, VV Olavarría, A Brunser, O Pontes-Neto, TEG Santos, H Arima, L Billot, ML Hackett, L Song, T Robinson, CS Anderson, HEADPOST (Head Positioning in Acute Stroke Trial) Investigators
Background The uptake of proven stroke treatments varies widely. We aimed to determine the association of evidence-based processes of care for acute ischemic stroke ( AIS ) and clinical outcome of patients who participated in the HEADPOST (Head Positioning in Acute Stroke Trial), a multicenter cluster crossover trial of lying flat versus sitting up, head positioning in acute stroke. Methods and Results Use of 8 AIS processes of care were considered: reperfusion therapy in eligible patients; acute stroke unit care; antihypertensive, antiplatelet, statin, and anticoagulation for atrial fibrillation; dysphagia assessment; and physiotherapist review. Hierarchical, mixed, logistic regression models were performed to determine associations with good outcome (modified Rankin Scale scores 0-2) at 90 days, adjusted for patient and hospital variables. Among 9485 patients with AIS, implementation of all processes of care in eligible patients, or "defect-free" care, was associated with improved outcome (odds ratio, 1.40; 95% CI, 1.18-1.65) and better survival (odds ratio, 2.23; 95% CI , 1.62-3.09). Defect-free stroke care was also significantly associated with excellent outcome (modified Rankin Scale score 0-1) (odds ratio, 1.22; 95% CI , 1.04-1.43). No hospital characteristic was independently predictive of outcome. Only 1445 (15%) of eligible patients with AIS received all processes of care, with significant regional variations in overall and individual rates. Conclusions Use of evidence-based care is associated with improved clinical outcome in AIS . Strategies are required to address regional variation in the use of proven AIS treatments. Clinical Trial Registration URL : . Unique Identifier: NCT02162017.


The study was supported by a project grant (1066966) from the National Health and Medical Research Council of Australia.



Journal of the American Heart Association, 2019, 8 (13), e012640

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/Organisation/COLLEGE OF LIFE SCIENCES/School of Medicine/Department of Cardiovascular Sciences


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Journal of the American Heart Association


Wiley, American Heart Association: JAHA , American Stroke Association



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