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Optimized Management of Endovascular Treatment for Acute Ischemic Stroke
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Impact of adherence to key performance indicators on mortality among patients managed for ischemic stroke

Mustapha Mohammed1, Hadzliana Zainal2, Balamurugan Tangiisuran3

  • 1School of Pharmaceutical Sciences. University of Science Malaysia. Pulau Pinang (Malaysia). macreener88@gmail.com.

Pharmacy Practice
|April 8, 2020
PubMed

Insights

Adherence to key performance indicators (KPI) for ischemic stroke care is suboptimal, particularly in DVT prophylaxis and rehabilitation. Lower nonadherence rates significantly reduce mortality risk in stroke patients.

Area of Science:

  • Neurology
  • Public Health
  • Healthcare Quality Improvement

Background:

  • Stroke is a leading global cause of death, with rising incidence in the Asia Pacific, especially Malaysia.
  • Existing ischemic stroke management guidelines lack exploration of Key Performance Indicator (KPI) adherence and its impact on patient mortality.

Purpose of the Study:

  • To assess the relationship between adherence to established Key Performance Indicators (KPIs) and mortality rates in ischemic stroke patients.
  • To identify specific areas of suboptimal KPI adherence in ischemic stroke management within the Malaysian context.

Main Methods:

  • A prospective cohort study of 579 first-ever ischemic stroke patients from the Malaysian National Neurology Registry (NNeuR).
  • Evaluation of baseline characteristics, risk factors, treatments, and six-month mortality outcomes.
  • Analysis of Key Performance Indicator nonadherence (NAR), with NAR > 25% considered suboptimal; relationship between NAR and mortality was assessed.

Main Results:

  • Overall six-month mortality was 4.0% (23 patients).
  • Suboptimal adherence was noted in Deep Vein Thrombosis (DVT) prophylaxis (82.8%), anticoagulation for atrial fibrillation (AF) (48.8%), and rehabilitation (26.2%).
  • Lower nonadherence (NAR < 2) was significantly linked to decreased mortality (OR 0.16), with higher nonadherence (NAR > 2) predicting increased mortality (p=0.05).

Conclusions:

  • Suboptimal adherence to Key Performance Indicators (KPIs) is significantly associated with increased mortality in ischemic stroke patients.
  • Improving adherence in areas like DVT prophylaxis, AF anticoagulation, and rehabilitation is crucial for better patient outcomes.
  • Continuous quality monitoring and implementation of evidence-based practices are essential for optimizing stroke care delivery.
Abstract

Keywords:
AnticoagulantsBrain IschemiaGuideline AdherenceMalaysiaMortalityProfessional PracticeProspective StudiesRegistriesRisk FactorsStrokeSurvival Analysis

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