In-hospital Initiation of Secondary Prevention Is Associated With Improved Vascular Outcomes at 3 Months

Rahiman, Abdul; Saver, Jeffrey L.; Porter, Verna; Buxton, William; McNair, Norma; Razinia, Tannaz; Ovbiagele, Bruce

doi:10.1016/j.jstrokecerebrovasdis.2007.09.004

« Previous Next »Journal of Stroke & Cerebrovascular Diseases
Volume 17, Issue 1 , Pages 5-8, January 2008

In-hospital Initiation of Secondary Prevention Is Associated With Improved Vascular Outcomes at 3 Months

Abdul Rahiman, MD, MPH
- Department of Neurology, University of California at Los Angeles School of Medicine, Los Angeles, California
Jeffrey L. Saver, MD
- Department of Neurology, University of California at Los Angeles School of Medicine, Los Angeles, California
Verna Porter, MD
- Department of Neurology, University of California at Los Angeles School of Medicine, Los Angeles, California
William Buxton, MD
- Department of Neurology, University of California at Los Angeles School of Medicine, Los Angeles, California
Norma McNair, RN
- Department of Nursing, University of California at Los Angeles Medical Center, Los Angeles, California
Tannaz Razinia, BS
- Department of Neurology, University of California at Los Angeles School of Medicine, Los Angeles, California
Bruce Ovbiagele, MD
- Department of Neurology, University of California at Los Angeles School of Medicine, Los Angeles, California
- Address correspondence to Bruce Ovbiagele, MD, Stroke Center and Department of Neurology, University of California at Los Angeles, 710 Westwood Plaza, Los Angeles, CA 90095.

Received 10 July 2007; accepted 12 September 2007.

Background

Although various in-hospital stroke quality improvement programs have been associated with high treatment rates at hospital discharge, there are few data on the impact of these programs on clinical outcomes. We evaluated the impact of the PROTECT (Preventing Recurrence Of Thromboembolic Events through Coordinated Treatment) program on short-term vascular risk.

Methods

Prospective data collected after discharge for ischemic stroke or transient ischemic attack caused by presumed atherosclerotic mechanism from a PROTECT intervention hospital and a comparison community hospital, which used conventional care, were compared. The 3-month follow-up clinical outcome data were then evaluated and differences in outcome frequency data between the two hospital groups were analyzed using Fisher's exact test. Covariate adjusted comparisons of percent with a vascular event was computed via logistic regression methods.

Results

A total of 224 patients met study criteria: 126 patients at a PROTECT hospital and 98 patients at a comparator hospital. The 3-month postdischarge data were available for 78 patients at PROTECT hospital versus 65 control patients. Patients at a PROTECT hospital were more likely to be younger, be current smokers, and not have a history of atrial fibrillation. At 3 months, there was a covariate-adjusted difference in the intervention-hospital group versus the control-hospital group with regard to the incidence of a vascular event (transient ischemic attack, stroke, or myocardial infarction), 8.4% versus 22% (P = .036).

Conclusions

Compared with conventional care, PROTECT was associated with better 3-month vascular outcomes after stroke hospitalization. Further study is needed to confirm the potential favorable impact of stroke quality improvement programs on clinical outcomes.

Key Words: Transient ischemic attack, stroke, ischemic, adherence, outcomes, prevention