American Heart Association program leads to substantial improvements in stroke care
For two decades now, the American Heart Association (AHA) Get With The Guidelines-Stroke program has been focused on improving stroke care in the United States. Established in 2003, the initiative has contributed to a dramatic enhancement in adherence to evidence-based stroke treatment, leading to better patient outcomes, according to a recent study of data from 2003 to 2022 among stroke patients.
To learn more, Cardiovascular Business spoke with Gregg C. Fonarow, MD, director of the Ahmanson-UCLA Cardiomyopathy Center, co-director of UCLA's preventative cardiology program and the Eliot Corday Chair in Cardiovascular Medicine and Science at UCLA. He said the program has grown to include nearly 3,000 U.S. hospitals, capturing data on over 75% of all acute ischemic strokes.
"The rate of patients being treated we started off with was around 20%, and we rapidly got that up to over 75%. In hospitals, we started to treat acute ischemic stroke with high-intensity statin therapy for those with stroke of atherosclerotic origin. That started off in single digits and is up above 80% with discharge antiplatelet therapy ... and there was chronic undertreatment of atrial fibrillation with anticoagulation, and with the Get With the Guidelines-Stroke program, we were able to get to rates that previously had not been described, above 90% of eligible patients without contraindications being discharged on oral anticoagulation," Fonarow explained.
Rather than focusing on isolated aspects of care, he said the initiative takes a comprehensive approach, improving early diagnosis, acute treatment, in-hospital secondary prevention measures and rehabilitation referrals. These efforts have transformed stroke care on a scale and duration never seen before, Fonarow said.
Key findings for measurable and lasting stroke care progress
The study assessed 43 well-validated quality measures over time. Remarkably, Fonarow said 41 of the 43 measures showed rapid and sustained improvement, demonstrating the effectiveness of the program’s interventions. This included faster treatment with intravenous thrombolytics, where the percentage of eligible patients receiving clot-busting treatment within the critical 60-minute window increased from 20% to more than 75%.
Reduced in-hospital mortality rates also declined significantly for acute ischemic stroke, intracerebral hemorrhage, and subarachnoid hemorrhage.
Addressing stroke treatment delays and disparities
While the program has driven significant progress, challenges remain, particularly in early stroke recognition and emergency response times. Delays in seeking care, often due to a lack of symptom recognition, continue to be a concern.
“Every minute counts in stroke care,” emphasized Fonarow. “Public awareness and swift emergency activation are crucial to improving outcomes.”
Additionally, disparities persist in treatment timing based on race, ethnicity, sex and age. Ongoing efforts focus on identifying and addressing these gaps through targeted interventions.
Fonarow said the sustained success of the Get With The Guidelines-Stroke program underscores the power of data-driven quality improvement.
“Providing hospitals with real-time feedback, setting clear benchmarks and sharing best practices have been instrumental in driving progress,” he explained.
Dave Fornell has covered healthcare for more than 17 years, with a focus in cardiology and radiology. Fornell is a 5-time winner of a Jesse H. Neal Award, the most prestigious editorial honors in the field of specialized journalism. The wins included best technical content, best use of social media and best COVID-19 coverage. Fornell was also a three-time Neal finalist for best range of work by a single author. He produces more than 100 editorial videos each year, most of them interviews with key opinion leaders in medicine. He also writes technical articles, covers key trends, conducts video hospital site visits, and is very involved with social media. E-mail: dfornell@innovatehealthcare.com