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“ Age-Related Differences in Characteristics, Performance Measures, Treatment Trends, and Outcomes in Patients with Ischemic Stroke ”

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  1. “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.

  2. 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.

  3. 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

  4. 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

  5. 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

  6. 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

  7. 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

  8. Clinical Implications Widespread application of GWTG-Stroke 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

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