The ABC's of Stroke Prevention: Reduction in Stroke Frequency Following a Quality Improvement Intervention by the Action Learning Network

Abstract

<h3>Purpose</h3> To assess the frequency of stroke among ventricular assist device patients following a quality improvement bundled intervention (the "ABCs of Stroke Prevention" [ABCs] which focused on Anticoagulation, Blood pressure, and Communication) within the Advanced Cardiac Therapies Improving Outcomes Network (ACTION). The bundle intervention comprised 3 interventions. These were: a document harmonizing how to implement and maintain bivalirudin infusion, a blood pressure management protocol and a daily stroke prevention checklist. <h3>Methods</h3> Baseline stroke outcomes prior to the formation of ACTION (Q3 2014 - Q2 2017) were obtained from Pediatric Interagency Registry for Mechanical Circulatory Support (Pedimacs). The CVA adverse event definition was used to assess stroke from Pedimacs. Stroke outcomes following implementation of the ABCs were obtained from the ACTION Outcome Registry Q1 2018-9/18/2020. <h3>Results</h3> A total of 693 patients (350 Pedimacs, 343 ACTION) and 887 devices (472 Pedimacs, 415 ACTION) were included. The overall stroke rate decreased following implementation of the ABCs from 14.6% to 10.4% (p=0.03) (Figure 1). The paracorporeal pulsatile pump stroke rate decreased from 30.1% to 8.2% (p<0.001) (Figure 2). <h3>Conclusion</h3> Stroke frequency has decreased following implementation of the ABCs. The most notable reduction has occurred in pulsatile paracorporeal pump patients where the stroke frequency has decreased more than 20%. Follow-up interventions are focused on further improving other device specific stroke outcomes and understanding patient specific risk factors.