US Surveillance of Acute Ischemic Stroke Patient Characteristics, Care Quality, and Outcomes for 2019.
US Surveillance of Acute Ischemic Stroke Patient Characteristics, Care Quality, and Outcomes for 2019.
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DOI：
10.1161/strokeaha.122.039098
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发表时间：
2022-11
期刊：
影响因子：
8.3
通讯作者：
Fonarow, Gregg C.
中科院分区：
文献类型：
--
作者：
Ziaeian, Boback;Xu, Haolin;Matsouaka, Roland A.;Xian, Ying;Khan, Yosef;Schwamm, Lee S.;Smith, Eric E.;Fonarow, Gregg C.
美国缺乏及时准确的全国范围内的急性缺血性中风(AIS)监测系统。我们使用GET与指南®(GWTG)-卒中注册来应用分层后调查权重，以生成对AIS流行病学、医院护理质量和住院结果的全国性评估。来自GWTG-卒中登记的临床数据使用贝叶斯内插法进行加权，该方法以国家住院患者样本(NIS)的观察为基础。为了生成2019年美国中风预测，我们对NIS的时间趋势估计进行了线性化，以预测2019年预期的AIS医院数量、分布和种族/民族特征。AIS流行病学和临床护理的主要指标包括患者和医院特征、中风严重程度、生命和实验室指标、治疗干预措施、绩效指标、处置和出院时的临床结果。我们估计，2019年美国医院收治了552,476名AIS患者。中位年龄71岁(IQR60-81)，48.8%为女性。22.6%诊断为心房颤动，30.2%有卒中/短暂性脑缺血发作史，36.4%有糖尿病史。基线时，46.4%的AIS患者正在服用抗血小板药物，19.2%的患者服用抗凝剂，46.3%的患者服用降胆固醇药物。死亡率为4.4%，出院时仅52.3%能独立行走。在全国范围内，除早期中风发作后3小时内使用溶栓剂外，其他所有指标的AIS成绩均高于95%(81.9%)。其他质量措施的合格率较低：吞咽困难筛查(84.9%)、早期溶栓治疗4.5小时(79.7%)和他汀类药物治疗(80.6%)我们使用贝叶斯分层后加权提供及时、可靠和可操作的美国全国AIS监测。这些数据可能有助于更有针对性的质量改进努力、资源分配以及改善AIS护理和结果的国家政策。
The U.S. lacks a timely and accurate nationwide surveillance system for acute ischemic stroke (AIS). We use the Get With The Guidelines® (GWTG) – Stroke registry to apply post-stratification survey weights to generate national assessment of AIS epidemiology, hospital care quality, and in-hospital outcomes. Clinical data from the GWTG-Stroke registry were weighted using a Bayesian interpolation method anchored to observations from the National Inpatient Sample (NIS). To generate a U.S. stroke forecast for 2019, we linearized time trend estimates from the NIS to project anticipated AIS hospital volume, distribution, and race/ethnicity characteristics for the year 2019. Primary measures of AIS epidemiology and clinical care included patient and hospital characteristics, stroke severity, vital and laboratory measures, treatment interventions, performance measures, disposition, and clinical outcomes at discharge. We estimate 552,476 patients with AIS were admitted in 2019 to US hospitals. Median age was 71 (IQR 60–81), 48.8% female. Atrial fibrillation was diagnosed in 22.6%, 30.2% had prior stroke/TIA, 36.4% had diabetes mellitus. At baseline 46.4% of AIS patients were taking antiplatelet agents, 19.2% anticoagulants, and 46.3% cholesterol-reducers. Mortality was 4.4% and only 52.3% were able to ambulate independently at discharge. Performance nationally on AIS achievement measures were generally higher than 95% for all measures but the use of thrombolytics within 3 hours of early stroke presentations (81.9%). Additional quality measures had lower rates of receipt: dysphagia screening (84.9%), early thrombolytics by 4.5 hours (79.7%), and statin therapy (80.6%) We provide timely, reliable, and actionable US national AIS surveillance using Bayesian interpolation post-stratification weights. These data may facilitate more targeted quality improvement efforts, resource allocation, and national policies to improve AIS care and outcomes.
通过在GET上使用指南 - 中风的患者注册表，对中风的护理和结果进行了全国监测质量的监视。
影响因子：
4
作者：
Ziaeian B;Xu H;Matsouaka RA;Xian Y;Khan Y;Schwamm LS;Smith EE;Fonarow GC
通讯作者：
Fonarow GC