Related Experiment Video

Updated: Jun 20, 2026

Optimized Management of Endovascular Treatment for Acute Ischemic Stroke
09:21

Optimized Management of Endovascular Treatment for Acute Ischemic Stroke

Published on: January 18, 2018

Influence of stroke subtype on quality of care in the Get With The Guidelines-Stroke Program

E E Smith1, L Liang, A Hernandez

  • 1Calgery Stroke Program, Hotchkiss Brain Institute, University of Calgary, Department of Clinical Neurosciences, Foothills Medical Centre, 1403 29 Street NW, Calgary, AB, Canada T2N 2T9. eesmith@ucalgary.ca

Neurology
|September 2, 2009
PubMed

Insights

Quality of care for hemorrhagic stroke (intracerebral hemorrhage and subarachnoid hemorrhage) is often lower than for ischemic stroke. However, participation in Get With The Guidelines-Stroke programs improves care quality for hemorrhagic stroke patients.

Area of Science:

  • Neurology
  • Public Health
  • Health Services Research

Background:

  • In-hospital care quality for hemorrhagic stroke subtypes, including intracerebral hemorrhage (ICH) and subarachnoid hemorrhage (SAH), is not well-established.
  • Existing research primarily focuses on ischemic stroke (IS) care.
  • Understanding care disparities is crucial for improving outcomes in all stroke types.

Purpose of the Study:

  • To examine and compare the quality of hospital-based care for ICH and SAH admissions against IS and transient ischemic attack (TIA) admissions.
  • To identify specific quality of care measures that are underutilized in hemorrhagic stroke.
  • To assess the impact of Get With The Guidelines-Stroke (GWTG-Stroke) program participation on care quality for hemorrhagic stroke.

Main Methods:

  • Analysis of 479,284 stroke and TIA admissions from 905 hospitals in the GWTG-Stroke database (April 2003–December 2007).
  • Calculation of quality measure adherence proportions, excluding ineligible patients or those with contraindications.
  • Use of logistic regression to compare quality measure compliance across stroke subtypes (ICH, SAH, IS, TIA), controlling for patient and hospital factors.

Main Results:

  • Hemorrhagic stroke admissions (ICH, SAH) showed lower adherence to many quality care measures compared to IS/TIA, including deep venous thrombosis (DVT) prevention for ICH and smoking cessation for SAH.
  • ICH patients had higher rates of rapid door-to-CT times and dysphagia screening compared to IS/TIA.
  • Increased duration of GWTG-Stroke program participation correlated with significant improvements in care quality for ICH and SAH patients, notably DVT prevention and smoking cessation.

Conclusions:

  • Significant underutilization of key acute care and preventive measures exists for ICH and SAH compared to IS/TIA.
  • The Get With The Guidelines-Stroke program demonstrates a positive association with improved quality of care for patients with hemorrhagic stroke.
  • Sustained participation in quality improvement programs is vital for enhancing hemorrhagic stroke management.
Abstract

Related Concept Videos

Ischemic Stroke l: Introduction01:15

Ischemic Stroke l: Introduction

Ischemic stroke is an acute cerebrovascular condition in which blood flow to a brain region is suddenly interrupted, leading to tissue infarction. Neurons depend on continuous oxygen and glucose supply, so even brief reductions in perfusion cause energy failure, ionic imbalance, and irreversible injury. Ischemic strokes are classified into thrombotic and embolic types based on their underlying mechanisms.Thrombotic MechanismsThrombotic stroke develops when a clot forms within a cerebral artery.
Stroke: Introduction and Types01:29

Stroke: Introduction and Types

A stroke is an acute neurological event caused by the sudden disruption of cerebral blood flow, leading to rapid loss of neuronal function. Neurons depend on continuous oxygen and glucose supply, so even brief interruptions can cause irreversible injury within minutes. Strokes are classified into ischemic and hemorrhagic types.Ischemic StrokeIschemic strokes are most common and occur due to arterial occlusion, depriving brain tissue of oxygen and nutrients. This leads to energy failure, ionic...
Regulation of Stroke Volume01:27

Regulation of Stroke Volume

The regulation of stroke volume, which is the amount of blood the heart pumps out during each heartbeat, is critical for maintaining a healthy circulatory system. Stroke volume is influenced by three main factors: preload, contractility, and afterload.
Preload refers to the degree of stretch on the heart before it contracts. It's analogous to the stretching of a rubber band; the more it's stretched, the more forcefully it snaps back. This concept is encapsulated in the Frank-Starling law of the...
Ischemic Stroke ll: Pathophysiology01:15

Ischemic Stroke ll: Pathophysiology

An ischemic stroke occurs when a cerebral blood vessel becomes obstructed, most often by a thrombus or embolus, interrupting the delivery of oxygen and glucose to brain tissue. Because neurons rely on continuous aerobic metabolism, energy failure begins within minutes of reduced perfusion. The region receiving the least blood flow becomes the infarct core, an area of irreversible cellular death. Surrounding this core lies the penumbra, a zone of hypoperfused but still viable tissue that is...
Hemorrhagic Stroke l: Introduction01:17

Hemorrhagic Stroke l: Introduction

A hemorrhagic stroke is an acute neurological event that occurs when a weakened cerebral blood vessel ruptures, allowing blood to accumulate within or around the brain. The sudden release of blood forms a focal hematoma that increases intracranial pressure, displaces neural tissue, and can obstruct cerebrospinal fluid pathways. These effects may be compounded by intraventricular extension of the hemorrhage, cerebral edema, or compression of adjacent structures, all of which contribute to...
Atherosclerosis IV: Nursing Management01:23

Atherosclerosis IV: Nursing Management

Nursing management for a patient with arteriosclerosis involves a comprehensive approach focusing on lifestyle modification, disease monitoring, education, and symptomatic care. Here is an overview of effective nursing strategies:Assessment and Monitoring: Initial and ongoing assessments are crucial. Nurses must document the patient's medical history, including any hypertension, diabetes, hyperlipidemia, and other cardiovascular diseases. Assessments also cover family history and lifestyle...