Abstract 3029: Improved Clinical Outcomes in Medicare Beneficiaries with Acute Ischemic Stroke During Initial Implementation of the Get With The Guidelines-Stroke (GWTG-S) Program 2003-2008

Abstract

Background: The first decade of the 21st century saw several changes in acute ischemic stroke care, including greater use of statins, tobacco cessation counseling, IV rt-PA, formally organized stroke centers, and national performance improvement programs. Changes in clinical outcomes from acute ischemic stroke during this period have not been fully delineated. Methods: We examined the national Medicare dataset to analyze clinical outcomes of ischemic stroke patients at hospitals joining Get With The Guidelines-Stroke (GWTG-Stroke) from April 1, 2003 to December 12, 2008. We designated three time periods of interest: 1) pre-period (6 months prior to GWTG-S participation, 2) early period (first 6 months of GWTG-Stroke participation), and 3) late period (6 to 18 months after GWTG-Stroke implementation). Clinical outcomes analyzed included discharge to home; inpatient, 30 day, and 1 year mortality; and 30 day and 1 year rehospitalization for stroke, cardiovascular event, and all cause. Results: 139,293 patients from 725 sites were included in the analysis. Mean age was 79.5 years, 41% male, 84% white. Patient demographics were similar across the three time periods, with minimal differences in comorbidities (e.g. diabetes, renal disease). Statistically significant changes between pre and late periods included: lower 30 day mortality (15.3% vs. 13.0%, p<.0001), lower 1 year mortality (28.0% vs 25.5%, p<.0001), lower stroke/TIA rehospitalization at 30 days (3.1% vs. 2.4%, p<.0001) and 1 year (9.2% vs. 8.7%, p<.002), lower rehospitalization for cardiovascular event at 30 days (2.9% vs. 2.3%, p<.0001) and 1 year (15.9% vs. 13.5%, p<.0001), and lower all cause rehospitalization at 30 days (17.4% vs. 15.1%, p<.0001) and 1 year (55.8% vs. 53.0%, p<.0001). Intermediate changes were seen during the early period. Rates of inpatient mortality and discharge to home did not change. Conclusions: During the first 2 years of participation, clinical outcomes for Medicare beneficiaries with acute ischemic stroke among hospitals joining GWTG-Stroke improved substantially, with 15% lower 30 day mortality rates and 24% lower 30 day rehospitalization rates for stroke or TIA. Further study is planned to determine if similar improvements in outcomes occurred at non-participating hospitals during this time frame.