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Quality of Care and Outcomes in Diabetic Patients with Ischemic Stroke

This research evaluates the quality of care and in-hospital outcomes of diabetic patients who have suffered an ischemic stroke. The study analyzes data from 415,926 patients and finds that diabetic patients had worse stroke-related outcomes and lower rates of receiving rt-PA treatment. However, they received cholesterol treatment at a higher rate than non-diabetic patients. These findings highlight the need for improvement in diabetes-related care during hospitalization for acute ischemic stroke.

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Quality of Care and Outcomes in Diabetic Patients with Ischemic Stroke

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  1. Quality of Care and Outcomes in Patients with Diabetes Hospitalized with Ischemic Stroke Findings From Get With The Guidelines-Stroke Reeves MJ; Vaidya RS; Fonarow GC; Liang L; Smith EE; Matulonis R; Olson DM; Schwamm LH.

  2. Background Diabetes is the 7th leading cause of death among the 24 million Americans who have it and approximately 1.6 million new cases are diagnosed each year.1 Diabetes is a common co morbidity in stroke patients and contributes to the poor outcomes that result after a stroke.2 1. Centers for Disease Control and Prevention. National diabetes fact sheet. 2008. 2. Sprafka JM, Virnig BA, Shahar E, McGovern PG. Trends in diabetes prevalence among stroke patients and the effect of diabetes on stroke survival; The Minnesota Heart Survey. Diabetes Med. 1994;11:678-684.

  3. Introduction Early and aggressive interventions are needed in the hospital setting to reduce the long term neurological effects and progression of cerebral injury. In addition, aggressive treatment of cardiovascular risk factors are also warranted to prevent future stroke reoccurrence. Idris I et al. Diabetes mellitus and stroke. Int J Clin Pract. 2006;60:48-56. Reeves MJ et al. www.strokejournals.org

  4. Objective Using the data from the ischemic stroke admissions in the GWTG-Stroke program, the purpose of the research is to evaluate the quality of care and in-hospital outcomes of diabetic patients who have suffered a stroke. Reeves MJ et al. www.strokejournals.org

  5. Methods Data were collected from 415,926 patients between April 1, 2003 and September 30, 2008, from 1070 GWTG-Stroke participating hospitals. Seven performance measures were used to evaluate the stroke quality of care and the six indicators that reflect American Stroke Association or American Diabetes Association were used to evaluate the quality of diabetes-related care. The relationships between diabetes and quality of care, in-hospital mortality and discharge at home were evaluated using multivariable logistic regression. Reeves MJ et al. www.strokejournals.org

  6. Results The results found that compliance with the stroke performance measures were similar in patients with and without diabetes except in patients receiving rt-PA. Only 54% of diabetic patients received rt-PA within 2 hours of onset as compared to 60.8% of non-diabetic patients; p value <0.0001). The use of cholesterol medication was higher in diabetic patients (79.3%) versus non-diabetic patients (71.2%); p value <0.0001). In evaluating the quality of diabetes care, the results showed that the compliance in following the diabetes-related quality metrics was the worse in HbA1c testing (44.9%) and an ACE-I/ARB at discharge was only given 58.3% of the time. Reeves MJ et al. www.strokejournals.org

  7. Compliance with Ischemic Stroke Performance Measures Among Diabetic and Non-Diabetic Patients Reeves MJ et al. www.strokejournals.org

  8. Conclusion Patients with diabetes had worse stroke-related outcomes and in receiving rt-PA treatment. But diabetic patients received cholesterol treatment at a higher rate than non-diabetic patients. Results may provide further impetus to improve diabetes related care during the hospitalization of acute ischemic stroke cases as well as improvement in the quality of care efforts to increase rt-PA treatment in patients with diabetes. Reeves MJ et al. www.strokejournals.org

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