Clinical Characteristics, Management, and In-Hospital Outcomes in Patients With Stroke or Transient Ischemic Attack in China.
Clinical Characteristics, Management, and In-Hospital Outcomes in Patients With Stroke or Transient Ischemic Attack in China.
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DOI：
10.1001/jamanetworkopen.2021.20745
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发表时间：
2021-08-02
影响因子：
13.8
通讯作者：
Wang YJ
中科院分区：
文献类型：
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作者：
Gu HQ;Yang X;Wang CJ;Zhao XQ;Wang YL;Liu LP;Meng X;Jiang Y;Li H;Liu C;Wangqin R;Fonarow GC;Schwamm LH;Xian Y;Li ZX;Wang YJ
中国急性脑卒中和短暂性脑缺血发作患者的当前临床特征、管理和住院结局是什么？在这项质量改进研究中，包括超过100万例入院，住院管理措施和结果因脑血管事件类型和医院护理水平而异。从2015年到2019年也观察到了时间上的改善。虽然随着时间的推移有所改善，但这些发现表明需要持续支持循证护理。中风是中国医疗保健系统的重大负担。中国卒中中心联盟成立于2015年，旨在监测和改善急性卒中和短暂性脑缺血发作（TIA）患者的护理质量和结局。评价中国卒中或TIA患者的临床特征、管理、住院临床结局和并发症。这项质量改进研究评估了2015年8月1日至2019年7月31日期间中国卒中中心联盟1476家参与医院的卒中或TIA入院情况。中风类型和日历年。11项基于指南的入院或出院管理措施和2项总结措施：全或无二元结果和综合评分（范围，0 [不依从]至1 [完全依从]），以评价循证卒中和TIA治疗依从性和院内临床结局，包括死亡或违背医嘱出院（DAMA）、重大心血管不良事件（MACE），包括缺血性卒中、出血性卒中，短暂性脑缺血发作或心肌梗死;以及院内并发症。在1006798例卒中或TIA患者中（平均[SD]年龄，65.7 [12.2]岁; 383 500人[38.1%]，838 229人缺血性卒中83.3%，TIA 64929例（6.4%），脑出血85705例（8.5%），蛛网膜下腔出血11241例（1.1%）。管理措施因脑血管事件类型而异，平均（SD）综合评分范围为SAH的0.57（0.31）至TIA的0.83（0.24）。SAH患者预后差和并发症发生率最高（21.9%; 95% CI，21.0%-22.8%院内死亡或DAMA; 9.6%; 95% CI，9.1%-10.2% MACE;和31.4%; 95% CI，30.6%-32.3%院内并发症）和ICH患者（17.2%; 95% CI，16.9%-17.5%院内死亡或DAMA; 9.3%; 95% CI，9.1%-9.5% MACE;和31.3%; 95% CI，31.0%-31.6%院内并发症），其次为缺血性卒中患者（6.1%; 95% CI，6.0%-6.1%院内死亡或DAMA; 6.3%; 95% CI，6.3%-6.4% MACE;和12.8%; 95% CI，12.7%-12.9%院内并发症），TIA患者最低（5.0%; 95% CI，4.8%-5.2%院内死亡或DAMA; 2.4%; 95% CI，2.3%-2.5% MACE;和0.8%; 95% CI，0.7%-0.8%院内并发症）。从2015年到2019年，观察到管理措施的时间改善，特别是静脉重组组织型纤溶酶原激活剂的给药（相对+60.3%; 95% CI，52.9%-70.5%），吞咽困难筛查（相对+14.7%; 95%CI，14.0%-15.6%），以及使用抗凝剂治疗房颤（相对+31.4%; 95%CI，25.7%-37.3%）。还观察到住院死亡或DAMA（相对-9.7%; 95%CI，-9.6%至-8.5%）和并发症（相对-27.1%; 95%CI，-28.6%至-25.3）的时间改善。在这项质量改进研究中，性能指标依从性和不良结局以及并发症因脑血管事件类型而异;尽管随着时间的推移有实质性改善，但这些结果表明需要支持使用循证实践。本质量改进研究检查了中国卒中中心联盟项目中卒中或短暂性脑缺血发作患者的性能指标和住院结局的变化和时间趋势。
What are the contemporary clinical characteristics, management, and in-hospital outcomes in patients with acute stroke and transient ischemic attack in China? In this quality improvement study that included more than 1 million admissions, in-hospital management measures and outcomes varied by type of cerebrovascular event and hospital level of care. Temporal improvements from 2015 to 2019 were also observed. Although improvements were seen over time, these findings suggest that ongoing support for evidence-based care is needed. Stroke represents a significant burden on the health care system of China. The Chinese Stroke Center Alliance was launched in 2015 to monitor and improve care quality and outcomes for patients with acute stroke and transient ischemic attack (TIA). To evaluate the clinical characteristics, management, and in-hospital clinical outcomes and complications among patients with stroke or TIA in China. This quality improvement study assessed stroke or TIA admissions to 1476 participating hospitals in the Chinese Stroke Center Alliance between August 1, 2015, and July 31, 2019. Stroke types and calendar year. Eleven guideline-based admission or discharge management measures and 2 summary measures: an all-or-none binary outcome and a composite score (range, 0 [nonadherence] to 1 [perfect adherence]) for adherence to evidence-based stroke and TIA care and in-hospital clinical outcomes, including death or discharge against medical advice (DAMA), major adverse cardiovascular events (MACEs), including ischemic stroke, hemorrhagic stroke, TIA, or myocardial infarction; and in-hospital complications. Of 1 006 798 patients with stroke or TIA (mean [SD] age, 65.7 [12.2] years; 383 500 [38.1%] female), 838 229 (83.3%) had an ischemic stroke, 64 929 (6.4%) had TIA, 85 705 (8.5%) had intracerebral hemorrhage (ICH), and 11 241 (1.1%) had subarachnoid hemorrhage (SAH). Management measures varied by cerebrovascular event type, with the mean (SD) composite score ranging from 0.57 (0.31) in SAH to 0.83 (0.24) in TIA. Poor outcomes and complications were highest among patients with SAH (21.9%; 95% CI, 21.0%-22.8% in-hospital death or DAMA; 9.6%; 95% CI, 9.1%-10.2% MACEs; and 31.4%; 95% CI, 30.6%-32.3% in-hospital complications) and patients with ICH (17.2%; 95% CI, 16.9%-17.5% in-hospital death or DAMA; 9.3%; 95% CI, 9.1%-9.5% MACEs; and 31.3%; 95% CI, 31.0%-31.6% in-hospital complications), followed by patients with ischemic stroke (6.1%; 95% CI, 6.0%-6.1% in-hospital death or DAMA; 6.3%; 95% CI, 6.3%-6.4% MACEs; and 12.8%; 95% CI, 12.7%-12.9% in-hospital complications), and lowest in patients with TIA (5.0%; 95% CI, 4.8%-5.2% in-hospital death or DAMA; 2.4%; 95% CI, 2.3%-2.5% MACEs; and 0.8%; 95% CI, 0.7%-0.8% in-hospital complications). Temporal improvements in management measures were observed from 2015 to 2019, especially in administration of intravenous recombinant tissue plasminogen activator (+60.3% relatively; 95% CI, 52.9%-70.5%), dysphagia screening (+14.7% relatively; 95% CI, 14.0%-15.6%), and use of anticoagulants for atrial fibrillation (+31.4% relatively; 95% CI, 25.7%-37.3%). Temporal improvements in in-hospital death or DAMA (−9.7% relatively; 95% CI, −9.6% to −8.5%) and complications (−27.1% relatively; 95% CI, −28.6% to −25.3) were also observed. In this quality improvement study, performance measure adherence and poor outcomes and complications varied by cerebrovascular event type; although there were substantial improvements over time, these results suggest that support for the use of evidence-based practices is needed. This quality improvement study examines variations in and temporal trends of performance measures and in-hospital outcomes in patients with stroke or transient ischemic attack in the Chinese Stroke Center Alliance program.
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影响因子：
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作者：
Gu, Hong-Qiu;Yang, Xin;Wang, Yong-Jun
通讯作者：
Wang, Yong-Jun
DOI：
10.1161/circoutcomes.109.921858
发表时间：
2010-05-01
影响因子：
6.9
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