Quality of Care and Ischemic Stroke Risk After Hospitalization for Transient Ischemic Attack
- 1 October 2015
- journal article
- research article
- Published by Ovid Technologies (Wolters Kluwer Health) in Circulation: Cardiovascular Quality and Outcomes
- Vol. 8 (6_suppl_3), S117-24
- https://doi.org/10.1161/circoutcomes.115.002048
Abstract
Background—: Patients with transient ischemic attack (TIA) are at increased risk for ischemic stroke. We derived a prediction rule for 1-year ischemic stroke risk post-TIA, examining estimated risk, receipt of inpatient quality of care measures for TIA, and the presence or absence of stroke at 1 year post discharge. Methods and Results—: We linked 67 892 TIA Get With The Guidelines-Stroke patients >65 years (2003–2008) to Medicare inpatient claims to obtain longitudinal outcomes. Using Cox proportional hazards modeling in a split sample, we identified baseline demographics and clinical characteristics associated with ischemic stroke admission during the year post-TIA, and developed a Get With The Guidelines Ischemic Stroke after TIA Risk Score; performance was examined in the validation sample. Quality of care was estimated by a global defect-free care measure, and individual performance measures within estimated risk score quintiles. The overall hospital admission rate for ischemic stroke during the year post-TIA was 5.7%. Patients with ischemic stroke were more likely to be older, black, and have higher rates of smoking, previous stroke, diabetes mellitus, previous myocardial infarction, heart failure, and atrial fibrillation. The Risk Score showed moderate discriminative performance (c-statistic=0.606); highest quintile patients were less likely to receive statins, smoking cessation counseling, and defect-free care. Although not associated with 1-year ischemic stroke, DCF was associated with a significantly lower risk of all-cause mortality. Conclusions—: TIA patients with high estimated ischemic stroke risk are less likely to receive defect-free care than low-risk patients. Standardized risk assessment and delivery of optimal inpatient care are needed to reduce this risk-treatment mismatch.Keywords
This publication has 31 references indexed in Scilit:
- Rates and factors associated with admission in patients presenting to the ED with TIA in the United States—2006 to 2008The American Journal of Emergency Medicine, 2013
- Representativeness of the Get With The Guidelines–Stroke RegistryStroke, 2012
- Prospective validation of the ABCD2 score for patients in the emergency department with transient ischemic attackCMAJ : Canadian Medical Association Journal, 2011
- Development of Stroke Performance MeasuresStroke, 2010
- Validation and Refinement of the ABCD2 ScoreStroke, 2009
- Linking inpatient clinical registry data to Medicare claims data using indirect identifiersAmerican Heart Journal, 2009
- Patterns and Predictors of Early Risk of Recurrence After Transient Ischemic Attack With Respect to Etiologic SubtypesStroke, 2007
- Combining Multiple Approaches for the Secondary Prevention of Vascular Events After StrokeStroke, 2007
- Incidence and Short-Term Prognosis of Transient Ischemic Attack in a Population-Based StudyStroke, 2005
- Very Early Risk of Stroke After a First Transient Ischemic AttackStroke, 2003