Research highlights importance of quality improvement programs in stroke care

New research published this month shows the key role quality improvement programs play in ensuring hospitals can adequately fight one of the biggest public health threats facing our country: stroke.

This new research, published in Stroke, the peer-reviewed scientific journal of the American Stroke Association, a division of the American Heart Association, shows Get With The Guidelines^® - Stroke has become an integral part of stroke clinical practice and research in the U.S. Nearly 8 million stroke cases have been entered into its registry from more than 2,800 hospitals, capturing about three-quarters of stroke hospitalizations across the country.

The study finds substantial and sustained improvements in acute stroke care among those in the quality improvement program. Reviewing two decades of data, researchers found increased adherence to evidence-based stroke care translates to better clinical outcomes and, ultimately, more patients being discharged home or to a skilled nursing facility more quickly.

Due to the importance of timely intervention, the time it takes to provide patients with ischemic strokes (clotted causes strokes) thrombolytic therapy (which uses medication to dissolve clots), also known as "door-to-needle time," is now a standard marker. In conjunction with the Association's Target: Stroke program, door-to-needle (DTN) time of less than one hour nearly quadrupled and improvement for DTN time within 45 minutes was even greater, increasing eight-fold. Similar improvements were also observed in endovascular therapy, which uses a catheter to access blood vessels and capture and remove the clot.

This is particularly relevant in the context of stroke care, where the goal is not only to save lives but also to restore function and maintain quality of life. Stroke is an exquisitely time-sensitive disease and Get With The Guidelines promotes delivery of evidence-based acute stroke care in a timely fashion, which in turn improves patient-centered clinical outcomes."

Gregg C. Fonarow, M.D., FAHA, American Heart Association volunteer, lead author of the study, director of the Ahmanson-UCLA Cardiomyopathy Center, co-director of the Preventative Cardiology Program and Eliot Corday Chair in Cardiovascular Medicine and Science at the University of California, Los Angeles 

Overall, the positive trends suggest concerted quality improvement initiatives can improve stroke care delivery and patient outcomes across diverse populations and locales, the authors say.

Stroke remains the No. 5 cause of death and the leading cause of long-term disability in the United States. When a stroke happens, early detection and treatment are key to improving survival, minimizing disability and accelerating recovery times. Yet, in the early 2000s, there was wide variability in management of stroke, and many patients did not receive recommended interventions. The American Heart Association, celebrating 100 years of lifesaving service as a global force for healthier lives for all, set out to change that.

In 2003, the Association launched Get With The Guidelines - Stroke, a hospital registry program designed to ensure patient care is aligned with the latest research- and evidence-based guidelines. Early results demonstrated that Get With The Guidelines implementation was associated with improvements in acute stroke care and secondary prevention.

Since the launch of the stroke program, Get With The Guidelines quality improvement modules have been added to cover atrial fibrillation, coronary artery disease, heart failure and resuscitation. Each program promotes consistent adherence to the latest research-driven guidelines and measurement, while providing data and information to professionals for continual improvement in patient care. All Get With The Guidelines modules are associated with significant improvements in multiple processes of care strongly linked to improved outcomes.

Study details, background and design:

• This registry-based retrospective observational cohort of all stroke and TIA admissions from hospitals participating in the Get With The Guidelines – Stroke program between April 2003 and December 2022.
• Their median age was 71; 51% were self-identified as female.
• The analysis examined patient characteristics, adherence to performance measures and in-hospital outcomes in patients hospitalized for acute ischemic stroke, subarachnoid hemorrhage, intracerebral hemorrhage and transient ischemic attack. Researchers quantified temporal changes in performance measure adherence and clinical outcomes over time.