Nurse-Coordinated and Guideline-Driven Care in Acute Ischemic Stroke: A Prospective Study With Retrospective...

To evaluate the efficacy of establishing a nurse-coordinated and guideline-driven care by advanced stroke nurses for acute ischemic stroke (AIS).

Specialised nursing care is usually not integrated enough to provide high quality of interdisciplinary care for patients with AIS.

A prospective study with retrospective controls.

A total of 231 patients with AIS were prospectively enrolled to receive the nurse-coordinated and guideline-driven care for intravenous thrombolysis (prospective cohort). A retrospective cohort using propensity-score matching at a 1:1 ratio retrieved reviews of 231 cases. The primary endpoint was early major improvement in the National Institute of Health Stroke Scale (NIHSS) scores at 24 h after thrombolysis. Secondary outcome measures included treatment time of each link at different stages, functional independence, EuroQoL 5-dimension three-level scale (EQ-5D-3L) scores and adverse events.

The rate of early major improvement in NIHSS score was 57.19% and 42.0% in the prospective and retrospective cohorts with a rate ratio of 1.361 (95% CI: 1.127-1.643) indicating superiority (p = 0.002). A higher rate of functional independence was observed in the prospective cohort as compared to controls (77.9% vs. 68.8%, p = 0.035). The mean time from admission was 17.11 ± 9.64 min for imaging, 21.75 ± 8.42 min for femoral artery puncture and 51.43 ± 9.64 min for thrombolysis in the prospective cohort, which were shorter than those in controls (all p < 0.001). EQ-5D-3L scores were better in prospective cases than in controls within 90 days after thrombolysis (all p < 0.05). A lower incidence of symptomatic intracranial haemorrhage was observed in the prospective cohort, while no significant difference in mortality up to 90 days was found between the two cohorts.

Although patients and the public were not directly involved in the design or conduct of this study, the research findings provide critical evidence that nursing-led, guideline-driven coordination directly improves the efficacy and safety in the management of patients with AIS by ensuring timely reaction, consistent application of evidence-based protocols and enhanced multidisciplinary teamwork.

Chinese Clinical Trial Registry: ChiCTR2200056818.