Healthcare Resource Availability, Quality of Care, and Acute Ischemic Stroke Outcomes.
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ABSTRACT:
SUBMITTER: O'Brien EC
PROVIDER: S-EPMC5523738 | biostudies-literature | 2017 Feb
REPOSITORIES: biostudies-literature
Publications
Healthcare Resource Availability, Quality of Care, and Acute Ischemic Stroke Outcomes.
O'Brien Emily C EC Wu Jingjing J Zhao Xin X Schulte Phillip J PJ Fonarow Gregg C GC Hernandez Adrian F AF Schwamm Lee H LH Peterson Eric D ED Bhatt Deepak L DL Smith Eric E EE
Journal of the American Heart Association 20170203 2
<h4>Background</h4>Healthcare resources vary geographically, but associations between hospital-based resources and acute stroke quality and outcomes remain unclear.<h4>Methods and results</h4>Using Get With The Guidelines-Stroke and Dartmouth Atlas of Health Care data, we examined associations between healthcare resource availability, stroke care, and outcomes. We categorized hospital referral regions with high-, medium-, or low-resource levels based on the 2006 national per-capita availability ...[more]
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Project description:Background: Post-ischemic inflammatory response might be affected by many factors. We chose leukocyte count as a marker of inflammatory response and investigated whether the effects of leukocyte count on the clinical outcomes in acute ischemic stroke patients are different according to different factors. Methods: We derived data from the China National Stroke Registry II. Patients with ischemic stroke were classified into four groups by leukocyte count quartiles within the first 24 h after admission. Adverse clinical outcomes were defined as recurrent stroke, all-cause death, and poor functional outcomes (3 ? mRS ? 5) at 3-months and 1-year follow-up. The subgroup factors were age, sex, history of hypertension, history of diabetes, history of previous stroke, or transient ischemic attack and smoking status. We assessed the association between leukocyte count and adverse clinical outcomes and evaluated this association in different subgroups. Results: A total of 14,678 patients were included. Patients in higher quartiles were likely to be younger, male, smokers, and drinkers, and to have a shorter time from symptom onset to arrival, a more proportion of history of diabetes, atrial fibrillation, and hypertension, and a higher severity of stroke. Higher quartiles were associated with elevated risk of adverse clinical outcomes at 3-months and 1-year follow-up. Leukocyte count had a moderate accuracy to predict clinical outcomes. There was no difference in the relationship between leukocyte count and adverse clinical outcomes across subgroups such as age, sex, history of hypertension, and smoking. The effect of leukocyte count on all-cause death was pronounced among patients with previous stroke or transient ischemic attack, and the effect of leukocyte count on short-term poor functional outcomes was also pronounced among patients without diabetes. Conclusions: Leukocyte count is associated with short-term and long-term clinical outcomes of acute ischemic stroke and may have predictive value, especially in patients with certain specific characteristics.
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