Transcript Document

“Age-Related Differences in Characteristics, Performance
Measures, Treatment Trends, and Outcomes in Patients with
Ischemic Stroke”
Gregg C. Fonarow, MD; Mathew J. Reeves, PhD; Xin Zhao,
MS; DaiWai M. Olson, PhD RN; Eric E. Smith, MD, MPH;
Jeffrey L. Saver, MD; Lee H Schwamm, MD; on behalf of the
GWTG-Stroke Steering Committee & Investigators.
Background
Older patients have a higher incidence and
prevalence of ischemic stroke and have worse
functional outcomes following stroke than younger
patients.1,2 The stroke rate more than doubles in
both men and women for each successive 10 years
after 55 years old.3 Population based studies
indicated that 65% of all strokes occur over the age
of 65.1,3
Fonarow GC et al. 2010
1. Lloyd-Jones D et al. Heart disease and stroke statistics--2009 update: a report from the American Heart
Association Statistics Committee and Stroke Statistics Subcommittee. Circulation. 2009;119:480-486.
2. Murray CJL et al. Alternative projections of mortality and disability by cause 1990–2020: Global Burden
of Disease Study. Lancet. 1997;349:1498–1504.
3. Rothwell PM et al. Population-based study of event-rate, incidence, case fatality, and mortality for all
acute vascular events in all arterial territories (Oxford Vascular Study). Lancet. 2005;366:1773-1783.
Introduction
• Data supports that stroke patients have worse
post stroke outcomes.
• These negative outcomes are due to the lack of
use of evidence based therapies in this patient
population.
• The American Heart Association's Get With The
Guidelines-Heart Failure (GWTG-HF) program
is a performance improvement initiative that
has been shown to improve the outcomes of
older patients suffering from acute ischemic
stroke.
Fonarow GC et al. 2010
Objectives
To evaluate age-related differences in
characteristics, performance measures,
temporal
trends,
and
in-hospital
outcomes for acute ischemic stroke
patients.
Fonarow GC et al. 2010
Methods
• Data was extracted by hospital personnel from 8 states.
The data included demographics, medical history, initial
head computerized tomography findings, in-hospital
treatment and events, discharge treatment and
counseling, mortality, and discharge destination.
• Data analyzed from hospitals participating in GWTG and
utilizing the web-based patient management tool for data
collection (Outcome Sciences Inc, Cambridge, MA)
• Patient cohort: 502,036 ischemic stroke admissions from
1,256 hospitals participating in the GWTG-Stroke
program from 2003-2009.
• Age was evaluated as a continuous variable and patients
were stratified by the following age groups: <50, 50-59,
60-69, 70-79, 80-89, ≥90 years, with a mean age of 71.0 ±
14.6 years.
Fonarow GC et al. 2010
Results
•
For each 10-year age increase, older patients had a higher in-hospital
mortality rate (adjusted OR 1.27, 95% CI 1.25-1.29) and were less likely
to be discharged home (adjusted OR 0.69, 95% CI 0.68-0.69).
•
The data showed that only 27% of the black patients under 50 years
old suffered from ischemic stroke but only 6.4% of the patient
population over 90 years old (P< 0.0001).
•
History of atrial fibrillation, hypertension, CAD/prior MI, and prior
stroke/TIA were the most common in older patients.
•
Patients between the ages of 60-69 had the highest rates of diabetes
while those 70-79 years old had the highest frequency of dyslipidemia.
For each 10-year age increase, older patients had a higher in-hospital
mortality rate (adjusted OR 1.27, 95% CI 1.25-1.29) and were less likely
to be discharged home (adjusted OR 0.69, 95% CI 0.68-0.69).
Fonarow GC et al. 2010
Conclusions
•
Get With The Guidelines–Stroke data demonstrated that there
are age related differences in demographics and clinical
characteristics among patients hospitalized with acute
ischemic stroke.
•
Although some age related differences existed between older
and younger patients suffering from ischemic stroke at the
beginning of the study period, evidence based treatment either
decreased or eliminated these differences by the end of the five
year study period.
•
This study suggest that GWTG-Stroke may have contributed to
the se improvements in care.
Fonarow et al. 2010
Clinical Implications
Widespread application of GWTGStroke should be considered as a
plausible strategy to facilitate eligible
patients with acute ischemic stroke
receiving optimal care irrespective of
age in the absence of contraindications
or patient preferences.
Fonarow GC et al. 2010