Abstract WP77: Changes in Acute Stroke Management and Outcomes in Korea Between 2013-2014 and 2018

Abstract

Purpose: The quality of acute stroke care can be improved through the nationwide compulsory quality assessment. Acute stroke quality assessment (ASQA) covers most acute stroke patients treated in acute care hospitals in Korea. We evaluated the changes of acute stroke management and outcomes between 2013/2014 and 2018 in Korea. Methods: We compared the most recent available ASQA data from 2018 with the data from 2013/2014. Patients with ischemic stroke (IS), subarachnoid hemorrhage (SAH), and intracerebral hemorrhage (ICH), who were admitted via emergency rooms within 7 days of onset at hospitals treating 10 or more cases during the each 3-month (2013, 2014) and 6-month (2018) survey period were selected. We grouped 2013 and 2014 into one group and compared them with 2018. Results: A total of 19,599 acute stroke cases in 2013/2014 and 28,286 cases in 2018 were enrolled at 216 and 248 nationwide hospitals, respectively. Age of stroke patients increased slightly (67.1±13.5 vs 68.2±13.8, p <0.001), and the proportion of stroke types slightly increased ICH and decreased SAH. The proportion of severe stroke was decreased. The number of hospitals equipped with stroke units increased. Mean bed size increased, but there was no difference in the number of stroke specialists by hospital. IVT and EVT were performed in 8.7% and 5.3% among IS patients in 2013/2014, respectively. In 2018, IVT rates decreased to 6.3% ( p <0.001), and EVT rates increased to 9.8% ( p <0.001). In particular, IVT rates significantly decreased from 1.3% to 0.2% in those over 80 years of age, and EVT rates increased from 0.7% to 2.4%. Decompressive surgery rates in ICH patients decreased slightly from 28.0% to 25.2% ( p =0.009). In SAH, clipping rates decreased from 34.7% to 24.3% ( p <0.001), and coiling rates increased significantly from 39.8% to 53.0% ( p <0.001). One-year mortality significantly decreased from 22.0% to 18.2% in all stroke patients ( p <0.001). Mortality decreased at 1 month and 3 months, also, and decreased in all patients with IS, ICH, and SAH. Conclusions: This study showed that while stroke patients had improved outcomes from 2013/2104 to 2018 in Korea, there is still room for improvement, particularly in IVT rates.