Adherence to Acute Care Measures Affects Mortality in Patients with Ischemic Stroke: The Florida Stroke Registry.
Adherence to Acute Care Measures Affects Mortality in Patients with Ischemic Stroke: The Florida Stroke Registry.
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DOI：
10.1016/j.jstrokecerebrovasdis.2020.105586
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发表时间：
2021-03
期刊：
影响因子：
--
通讯作者：
Sacco RL
中科院分区：
文献类型：
--
作者：
Gardener H;Rundek T;Lichtman J;Leifheit E;Wang K;Asdaghi N;Romano JG;Sacco RL
急性中风治疗中的种族/民族差异如何导致结果差异尚不清楚。我们按种族/民族检查了急性卒中护理措施与第一年死亡率和30天再入院之间的关系。该研究纳入了2010-2013年在佛罗里达卒中登记处的66家医院治疗的年龄≥65岁缺血性卒中的按服务收费医疗保险受益人。卒中护理指标包括静脉注射阿替普酶治疗、院内抗血栓治疗、DVT预防、出院抗血栓治疗、抗凝治疗、他汀类药物使用和戒烟咨询。我们使用混合逻辑模型评估脑卒中护理与死亡率（住院、30天、6个月、脑卒中后1年）和再入院之间的关系，并根据人口统计学、脑卒中严重程度和血管危险因素进行调整。在全部研究人群中的14,100例缺血性卒中患者（73%白人，11%黑人，15%西班牙裔）中，住院死亡率为3%，30天死亡率为12%，6天死亡率为21%，10天死亡率为26%，30天内再次住院死亡率为15%。早期和出院时接受抗血栓药物治疗的患者在所有时间点的死亡率都较低，并且早期使用抗血栓药物的保护性关联在白人中最强。在出院时接受他汀类药物治疗的符合条件的患者死亡率降低了6%和1%，但在少数群体中尤其如此。他汀类药物治疗与较低的30天再入院率相关。急性卒中护理措施，特别是抗血栓治疗和他汀类药物治疗，与降低长期死亡率的几率相关。这些急性护理措施的好处在西班牙裔患者中不太可能出现。结果强调了优化急性脑卒中护理对所有患者的重要性。
How race/ethnic disparities in acute stroke care contribute to disparities in outcomes is not well-understood. We examined the relationship between acute stroke care measures with mortality within the first year and 30-day hospital readmission by race/ethnicity. The study included fee-for-service Medicare beneficiaries age ≥65 with ischemic stroke in 2010–2013 treated at 66 hospitals in the Florida Stroke Registry. Stroke care metrics included intravenous Alteplase treatment, in-hospital antithrombotic therapy, DVT prophylaxis, discharge antithrombotic therapy, anticoagulation therapy, statin use, and smoking cessation counseling. We used mixed logistic models to assess the associations between stroke care and mortality (in-hospital, 30-day, 6-month, 1-year post-stroke) and hospital readmission by race/ethnicity, adjusting for demographics, stroke severity, and vascular risk factors. Among 14,100 ischemic stroke patients in the full study population (73% white, 11% Black, 15% Hispanic), mortality was 3% in-hospital, 12% at 30d, 21% at 6m, 26% at 1y, and 15% had a hospital readmission within 30 days. Patients who received antithrombotics early and at discharge had lower mortality at all time points, and the protective association for early antithrombotic use was strongest among whites. Eligible patients who received statin therapy at discharge had decreased 6m and 1y mortality, but specifically among minority groups. Statin therapy was associated with lower 30-day hospital readmission. Acute stroke care measures, particularly antithrombotic use and statin therapy, were associated with reduced odds of long-term mortality. The benefits of these acute care measures were less likely among Hispanic patients. Results underscore the importance of optimizing acute stroke care for all patients.
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影响因子：
168.9
作者：
Emberson, Jonathan;Lees, Kennedy R.;Lyden, Patrick;Blackwell, Lisa;Albers, Gregory;Bluhmki, Erich;Brott, Thomas;Cohen, Geoff;Davis, Stephen;Donnan, Geoffrey;Grotta, James;Howard, George;Kaste, Markku;Koga, Masatoshi;von Kummer, Ruediger;Lansberg, Maarten;Lindley, Richard I.;Murray, Gordon;Olivot, Jean Marc;Parsons, Mark;Tilley, Barbara;Toni, Danilo;Toyoda, Kazunori;Wahlgren, Nils;Wardlaw, Joanna;Whiteley, William;del Zoppo, Gregory J.;Baigent, Colin;Sandercock, Peter;Hacke, Werner
通讯作者：
Hacke, Werner
影响因子：
8.3
作者：
Oluwole, Sofia A.;Wang, Kefeng;Rundek, Tatjana
通讯作者：
Rundek, Tatjana
影响因子：
9.9
作者：
Messe, Steven R.;Khatri, Pooja;Schwamm, Lee H.
通讯作者：
Schwamm, Lee H.
影响因子：
8.3
作者：
Sacco, RL;Boden-Albala, B;Shea, S
通讯作者：
Shea, S
影响因子：
8.3
作者：
HOWARD, G;ANDERSON, R;BURKE, GL
通讯作者：
BURKE, GL