Enhancing Comorbidity Management in Patients With Hemorrhagic Stroke via an Electronic Health Record-Linked Best...

Survivors of hemorrhagic stroke exhibit a high burden of cerebrovascular risk factors, including hyperlipidemia and diabetes, which can impact future risk of recurrence and major adverse cardiovascular events. Systematic evaluation and management of these comorbidities during hospitalization remains suboptimal, despite the availability of effective treatment strategies. This study aimed to determine whether an electronic health record-based intervention improves assessment and management of hyperlipidemia and diabetes after hemorrhagic stroke.

We conducted a prospective cohort study comparing a historical cohort of 314 consecutive patients with primary intracerebral hemorrhage (2016-2019) with a prospective intervention cohort of 296 patients with hemorrhagic stroke (2023-2024) at a single tertiary care center. The intervention was composed of an electronic health record-deployed best practice alert to prompt providers to order low-density lipoprotein cholesterol (LDL-C) and glycated hemoglobin (HbA_1c) levels. We compared the cumulative incidence of LDL-C and HbA_1c evaluation before and after intervention through Gray's test and assessed the effectiveness of the intervention using a multivariable Fine and Gray model, adjusted for relevant confounders. Finally, we evaluated changes in the treatment intensification of suboptimal LDL-C and HbA_1c levels between the 2 periods using χ² and Fisher exact tests.

Following the intervention, the cumulative incidence of HbA_1c and LDL-C evaluations increased significantly, with HbA_1c measurements rising from 57.9% to 75.8% (P<0.001) and LDL-C from 55.3% to 72.4% (P<0.001). The Fine and Gray model demonstrated a 61% increase in the subdistribution hazard for both evaluations during the intervention period (LDL-C: hazard ratio [HR], 1.61 [95% CI, 1.34-1.94]; P<0.001; HbA_1c: HR, 1.61 [95% CI, 1.35-1.93]; P<0.001). Despite improvements in comorbidity assessments, no significant changes were observed in treatment intensification for abnormal HbA_1c/LDL-C values.

Our electronic health record-based intervention significantly improved the proportion of patients with hemorrhagic stroke evaluated for key comorbidities during acute hospitalization. However, future studies are needed to assess whether increased evaluations improve long-term management and outcomes.

URL: Clinicaltrials.gov; Unique Identifier: NCT05643001.