Impact of Evidence‐Based Stroke Care on Patient Outcomes: A Multilevel Analysis of an International Study
Journal
Journal of the American Heart Association
ISSN
2047-9980
Date Issued
2019
Author(s)
Xian Li
Sandy Middleton
Caroline Watkins
Octavio Pontes‐Neto
Taiza E. G. Santos
Hisatomi Arima
Laurent Billot
Maree L. Hackett
Lily Song
Thompson Robinson
Craig S. Anderson
Gillian Mead
H. Asita De Silva
Jeyaraj D. Pandian
Ruey‐Tay Lin
Tsong‐Hai Lee
Liying Cui
Bin Peng
Stephane Heritier
Richard Lindley
Stephen Jan
Elizabeth Boaden
Christopher P. L. H. Chen
Anne Forster
Laurent Billot
Mark Woodward
Kris Rogers
Anish Scaria
Joyce Y. Lim
Natalie Espinosa
Lucy McEvoy
Lee Blackburn
Sarah S. Richtering
Shoujiang You
Simon Ladwig
Gabrielle P. Merritt
Bryce Thomsen
Kerry Jenson
Penelope Gordon
Dennis Ryan Nguyen
Wei Wei Quan
Tessa Pei‐Yi Lo
Jonathan Lim
Selena Goh
Leibo Liu
Mirza Ahmad Baig
Ravider Singh
Paul Donnelly
Manuela Armenis
Marna Van Zyl
Helen Monaghan
Phillipa Smith
Parisa Glass
Fanli Zhou
Yun Shen
Li Lei
Di Li
Ting Zhang
Xiaoyan Zhang
Yun Peng
Lingling Feng
Zhiping Ye
Philip Gregory
Jeyaraj D. Pandain
Deepti Arora
Pablo M. Lavados
GONZALEZ, FRANCISCA
Bernardita Portales
Octavio Pontes‐Neto
Taiza Santos‐Pontelli
Brunna Rimoli
Monica Braga
Carolina Vidal
Dafna Benadof
Rodrigo J. Rivas
Laura Carvallo
Pamela Carvallo
Rubia Miranda
Brunna Pileggi
H. Asita de Silva
Shalomi Weerawardena
Thanushanthan Jeevarajah
Devaki Dharmawardena
Dumindi Ranasinghe
Matheesha Dharshana
Nilesh Nandadeva
Savithri Nawarathna
Ruey‐Tay Lin
Tsong‐Hai Lee
Jiu‐Haw Yin
Shoou‐Jeng Yeh
Ruei‐Jen Ma
Caroline L. Watkins
Gemma Whiteley
Denise Forshaw
Catherine Elizabeth Lightbody
Joanna Cox
Jane Fitzgerald
John F. Heney
Helen Byfield
Simone Finley
Hayley E. Tyrer
Carole Bruce
Alison Gibbon
Brett Jones
Emma Siracusa
Koushik Gowda
Shahla Cowans
Briana Forman
Sherin Jacob
Kristine Caprecho
Roshan Khatri
Po Yi Wan
Maria Lopez
Sifiso Vanika
Wilhelmina Bleeker
Marinka Ireland
Sheila Jala
Susan Day
Eric Ha
Martin Krause
Melissa Passer
Sarah Giaccari
Nadia Burkolter
Michael Braithwaite
Kylie Tastula
Darshan Ghia
Tapuwa Musuka
Anthony Alvaro
Gillian Edmonds
Nicole O'Loughin
Rebecca Phair
Joanne Kaoutal
David J. Blacker
Belinda L Saint
Kim Parrey
Michelle Coad
Matthew Kinchington
Nishantha Senanayake
Johanna Alaban
Irma Kuehne
Taiza Santos‐Pontelli
Monica Braga
Brunna Rimoli
Millene Camilo
Milena Libardi
Sheila Martins
Batista Carlos
Magda Martins
Leonardo Carbonera
Andrea Almeida
Martin Kelin
Carla Pauli
Mariana Lunardi
Luciane Silveira
Olga Chagas
Daily Souza
Gabriel Braga
Priscila Ribeiro
Gustavo Luvizutto
Marcia Polin
Fernanda Winckler
Jinfeng Liu
Zhenjiang Wang
Huibing Wang
Suying Lin
Jing Dong
Junshan Zhou
Suping Qin
Hui Zhan
Yongquan Xue
Dong Tian
Dan Yang
Yan Yin
He Li
Changming Geng
Jieyi Liu
Xiaolin Jiang
Yujun Wu
Wei Sun
Bingqi Yu
Yanmei Guan
Qin Wang
Bo Wei
Huirong Wang
Yan Wang
Liwen Tai
Wenchao Zhang
Weili Zhao
Xueying Wang
Guoli Li
Zhiming Ni
Fudong Guo
Lan Cen
Jun Lu
Zheng Chen
Guoming Yin
Yingchun Wang
Jiping Zheng
Zhimin Zhou
Hongquan Wang
Renlin Zou
Bin Xue
Airu Li
Jing Guo
Ying Guo
Xingguo Jiang
Xiuge Tan
Chunpeng Zhang
Bei Shao
Xiaoting Niu
Chunfeng Liu
Dongqin Chen
Ping Liang
Xia Zhang
Chunqing Zhang
Wenjie Gong
Zhichao Huang
Huihui Liu
Shoujiang You
Junying Huang
Rongfang Shi
Cuilan Wang
Ying Liu
Jinchao Wang
Guojun Wu
Zhihong Gao
Qunli Lin
Cong Xu
Huile Zheng
Xinghai Ye
Xiaoqiong Jin
Junyan Liu
Xiaoyun Cao
Yan Zhang
Jinyang Wang
Yuzhu Xu
Yan Li
Xin Ma
Qi Kong
Yanlei Hao
Baojun Qiao
Hui Yan
Zhiyong Huang
Baoqiang Chang
Jinjin Yan
Pinjun Liao
Wei Zhang
Ling Liu
Tingting Zhu
Xuehui Liu
Yongping Li
Ruifang Dong
Miao Chen
Xiaoli Ge
Hairong Wang
Lihua Dai
Jiafu Liu
Shixia Wang
Jihui Du
Aixiu Song
Yunhai Li
Jie Feng
Cheng Yu
Honglin Feng
Xiaojia Sun
Ruihong Sun
Weisong Liu
Jianfeng Liu
Xuesheng Lu
Enzhuo Chen
Wei Gao
Hui Liu
Heping Wang
Yanxia Wang
Juan Song
Dongqi Liu
Wenhui Du
Guixia Li
Cuiling Li
Yanling Liang
Xuekun Cai
Jinli Zhang
Xiaowei Tao
Pingshun An
Ranran Tang
Xu Qin
Yingling Wang
Wenjun Zhang
Rong Ma
Xiaoqiong Huang
Yonglin Liu
Yazhi Wang
Ping Fan
Hailan Yang
Lianyuan Feng
Jianxia Zhi
Jiewen Zhang
Yao Zhou
Danhong Wu
Haiyan He
Xiaohong Chen
Yongge Hou
Xiaohui Su
Liying Cui
Bin Peng
Siyuan Fan
Luis Suárez
Juan de Dios Polanco
Patricio Sotomayor
Ricardo Urzúa
Daniela Urrutia
Nathalie Conejan
Arturo Escobar
Monica Gonzalez
Danisa Vargas
Angel Constante
Erika Vásquez
Elizabeth Godoy
Christian Figueroa
Vanesa San Martin
Nataly Vidal
Madeleyn Muñoz
María Spencer
Ignacio Acosta
Rodrigo Guerrero
Prudencio Lozano
Camila Aguayo
Jimena Pizarro
Alvaro Soto
Flor Bonilla
Pía García
Carolina Del Castillo
Marcela Grandjean
Alexis Von Johnn
Ignacio Gutierrez
Francisca Rivero
Ignacio López
Federico Silva
Marlen Pachón
José Mendoza
Alexander Pabón
Mahesh Kate
Naushad Akhtar
Gibbsdeep S. Narang
Ashish Deepak
Vikram Huded
Romnesh De Sowza
Alben Sigamani
Karthikeyan Rajendran
Anisha Vishwanath
Anusha K
Somasundaram Kumaravelu
Syed Rahamath
Sandeep Kannneganti
Dheeraj Khurana
Cheena Katoch
Taranpreet Kaur
Ummer Karadan
Anu Kuriakose
Jaison John
Mumthaz Basheer
Harsha Hemal Gunasekara
Gamlath Chandima Udeni De Silva
Peetagam Harshi Lakmali Ubeywickrama
Kavisha Chathumali Silva
Eshani Anuradha De Silva
Udaya Ranawaka
Chamila Mettananda
Yamuna Nanayakkara
Tharini Mendis
Gayathri Fernando
Ahamed Imthikab
Kandula Pieris
Saman B. Gunatilake
Pamuditha M. W. Madanayake
Shiran A. Paranavitane
Bimsara Senanayake
Vaidhehi Vishwanathan
Maathury Sivapalan
Ruwangi U. Murage
Uthpala Chandradeva
Ruey‐Tay Lin
Yao‐Hua Liu
Chih‐Lung Lin
Hsiu‐Fen Lin
Kuan‐Ting Liu
Chien‐Fu Chen
Meng‐Ni Wu
Su‐Hua Tsai
Chi‐Ching Chen
Lan‐Yi Chen
Tsong‐Hai Lee
Chien‐Hung Chang
Yeu‐Jhy Chang
Kuo‐Lun Huang
Ting‐Yu Chang
Chi‐Hung Liu
Chen‐June Seak
Yu‐Li Lin
Jia‐Yi Luo
Hsiao‐Ying Yang
Ching‐Yi Wang
Lung Chan
Chaur‐Jong Hu
Nai‐Fang Chi
Dean Wu
Yao‐Hsien Huang
Yi‐Chun Kuan
Chien‐Tai Hong
Yi‐Chun Chen
Yu Sun
Cheng‐Huai Lin
Chien‐Jung Lu
Hai‐Jui Chu
Yi‐Chia Lo
Wen‐Hui Chang
Wan‐Jung Lin
Hui‐Chen Su
Tien‐Yu Lin
Chi‐Hsuan Cho
Shu‐Lan Lu
Ya‐Fang Hsueh
Ching‐Yi Lai
David Jarrett
Claire James
Stacey Valentine
Clare Whistler
Rebecca Butler
Simone Browning
Caroline Watchurst
Renuka Erande
Emma Elliott
Krishna Patel
Maria Brezitski
Caroline Hogan
Asra Banaras
Lucinda Crook
Rashidat Ahmed
Lindsay Potter
Rosie Laird
Natasha Clarke
Alison Loosemore
J. Godber
Sara Gawned
K. A. Hamilton
Rachael Jones
Paul Guyler
Sharon Tysoe
Raji Prabakaran
Sweni Shah
Joanne Calver
Laszlo K. Sztriha
Maria Fitzpatrick
Stephanie Drysdale
John Aeron‐Thomas
Emma McKenzie
Belinda Chitando
Paul Willcoxson
Elizabeth Iveson
Peter Wanklyn
Natasha Dyer
Michael Keeling
Romina Rodriguez
Kerry Elliott
Mia Porteous
Mark O'Neill
Sheridan Orme
Carla Richardson
Janet Tomlinson
Suzanne Hawkins
Delia Bester
Carol Jeffs
Joanne Howard
Pauline Brown
Deborah Ward
Jennifer Turfrey
Leanne Raybould
Allison Bates
Sue O'Connell
Margaret O'Connor
Samantha Williams
Hedley C. A. Emsley
Alison McLoughlin
Sonia Raj
Bindu Gregary
Donna Doyle
G. M. Courtauld
C. Schofield
L. Lucas
A. Lydon
A. James
Kari Saastamoinen
Laura Howaniec
Premchand Daboo
Ali N. Ali
Emma Richards
Joanne Howe
Christine Kamara
Kathy Stocks
Ralf Lindert
Diana J. Day
Sarah Finlay
Joanne McGee
Jennifer Mitchell
Elaine Amis
Rosemary Macey
Suzanne Tauro
Lauren Henry
Sarah Cuddy
Andrew Steele
Kerry Mullen
Sarah Kirker
Murudappa Bhattad
Michael Carpenter
Prabal Datta
Ann Needle
Linda Jackson
Julie Ball
Rosie Beckitt
Nicola Chivers
Angela Bowring
Sara Eddy
Kevin Thorpe
Samantha Keenan
Alison Griffin
Stuart Maguire
Chris Patterson
Hawraman Ramadan
Ruth Bellfield
Michaela Hooley
Kelvin Stewart
Lucy Williams
Cara Gurney
Deborah Oliver
Maria Gardiner
Sarah Grayland
Mohit Bhandari
David M. Collas
Tolu Adesina
Saul Sundayi
Ruth Harvey
Emma Pope
Audrey Lam
Elaine Walker
Colin Merrill
Soma Banerjee
Kirsten Hannah Harvey
Sheila Mashate
Peter Wilding
Linda Johnson
Robert Namushi
Patricia Jacob
Sreeman Andole
Karen Dunne
Naveen Gadapa
Sam King
Sonata Siliuzaite
Sharon Dealing
Karen Attwood
Annette Woods
Banher Sandhu
Maam Mamun
Afzal Mahmood
June Jones
Abimbola Ojo
Denise Carter‐Evans
Royal Liverpool
Aravind Manoj
Glyn Fletcher
Paula Lopez
Jill Greig
Matthew Robinson
Sarah Jones
Lorinda Jones
Claire West
Helen Tench
Rachel Gascoyne
Amanda Whileman
Emily Hall
Stephanie Wright
Julie Toms
Janet Tomlinson
Duke Phiri
Sakthivel Sethuraman
Niaz Mohammed
Frances Justin
Margaret Louise Tate
Meena Chauhan
Syed I. Haider
Arumugam Nallasivan
Tim Webster
Sandra Leason
Samantha Seagrave
Peterborough City Hospital
Peter Owksu‐Agyei
Natalie Temple
Nicola Butterworth‐Cowin
Frederick Magezi
Leicester Royal Infirmary
Shagufta Khan
Claire Stephens
Amit Mistri
Aidan Murphy
Manda Lam
Paul Underwood
Catherine Thompson
Clare Buckley
Diane Wood
Sarah Board
Linda Howard
Ashraf Ahmed
Bethany Oates
Sara Leonard
Royal Bournemouth Hospital
Royal Bournemouth
Kamy Thavanesan
Michelle Dharmasiri
Sathyabama Logianathan
Catherine Ovington
Gail Hann
Chantel Cox
Craigavon Area Hospital
Southern Health
Social Care Trust
Catherine Douglas
Michael Goggin
Patricia Fearon
Sara Gilpin
Margaret O'Hagan
Pilgrim Hospital
Anne Hardwick
Kimberley Netherton
Judith Quinn
Tulu Bozkaplan
Josin Jose
Type
Resource Types::text::journal::journal article
DOI
URL
Abstract
<jats:sec xml:lang="en"> <jats:title>Background</jats:title> <jats:p xml:lang="en"> The uptake of proven stroke treatments varies widely. We aimed to determine the association of evidence‐based processes of care for acute ischemic stroke ( <jats:styled-content style="fixed-case">AIS</jats:styled-content> ) 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. </jats:p> </jats:sec> <jats:sec xml:lang="en"> <jats:title>Methods and Results</jats:title> <jats:p xml:lang="en"> Use of 8 <jats:styled-content style="fixed-case">AIS</jats:styled-content> 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% <jats:styled-content style="fixed-case">CI</jats:styled-content> , 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% <jats:styled-content style="fixed-case">CI</jats:styled-content> , 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. </jats:p> </jats:sec> <jats:sec xml:lang="en"> <jats:title>Conclusions</jats:title> <jats:p xml:lang="en"> Use of evidence‐based care is associated with improved clinical outcome in <jats:styled-content style="fixed-case">AIS</jats:styled-content> . Strategies are required to address regional variation in the use of proven <jats:styled-content style="fixed-case">AIS</jats:styled-content> treatments. </jats:p> </jats:sec> <jats:sec xml:lang="en"> <jats:title>Clinical Trial Registration</jats:title> <jats:p xml:lang="en"> <jats:styled-content style="fixed-case">URL</jats:styled-content> : <jats:ext-link xmlns:xlink="http://www.w3.org/1999/xlink" ext-link-type="uri" xlink:href="https://www.clinicaltrials.gov">https://www.clinicaltrials.gov</jats:ext-link> . Unique Identifier: <jats:styled-content style="fixed-case">NCT</jats:styled-content> 02162017. </jats:p> </jats:sec>