Those at the Highest Risk for Recurrent TIA or Stroke Are Least Likely to Receive Optimal Care

Among patients who have had transient ischemic attacks (TIAs), those who are in the highest risk category were least likely to receive optimal care to prevent future hospitalizations for TIA or stroke.

In a presentation; “Readmission for Stroke and Quality of Care Among Hospitalized Patients With Transient Ischemic Attack: Real World Delivery of Care,” Emily C. O’Brian, PhD, instructor, Duke University School of Medicine, presented results from the American Heart Association’s Get With the Guidelines (GWTG)-Stroke program.

Researchers used data for 58,809 TIA patients aged over 65 years enrolled in the GWTG-Stroke Registry (2003-2008). They estimated the risk for 1-year hospital admission for stroke or subsequent TIA using demographics and past medical history. The cohort was then divided into 5 groups based on their degree of risk. Researchers then assessed the quality of care based on 5 metrics reflecting whether eligible patients received: early antithrombotics, discharge antithrombotics, anticoagulants for patients with atrial fibrillation, anticoagulation therapy, statins for low-density lipoprotein cholesterol (LDL-C) levels greater than 100 mg/dL, and smoking cessation counseling. Researchers then calculated a defect-free care (DFC) measure to reflect the overall quality of care.

The study found the risk of readmission was 11.8% overall. Disparities between the lowest and highest risk categories were found for receipt of statins, anticoagulation therapy, smoking cessation counseling, and DFC. The quality-of-care metric for those with elevated LDL-C was least optimal. For the healthiest group of patients, approximately two-thirds received a statin. By comparison, approximately 56% received a statin.

The GWTG program is AHA’s hospital improvement program designed to improve adherence to evidence-based care. The program provides hospitals with a Web-based patient management tool, decision support, and real-time benchmarking capabilities. The GWTG-Stroke Fact Sheet can be found on the AHA website (https://www.heart.org/idc/groups/heart-public/@wcm/@private/@hcm/@gwtg/documents/downloadable/ucm_310976.pdf).

Dr O’Brian noted that protocols for optimal treatment are already in place to help remind healthcare providers of the appropriate care for a particular patient. “We already have a tool that reminds hospitals to follow recommendations ranging from hospital admission to helping the patient out the door,” Dr O’Brian said in an interview. However, more steps can be taken to ensure that the patients who are at highest risk are given the appropriate treatments. “Standard risk assessment delivery of optimal TIA patient care is needed.”