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Vascular Risk Factor Control in the Year After Ischemic Stroke Versus Myocardial Infarction
Bravata DM, Brosch J, Sico J, Baye F, Myers L, Roumie CL, Cheng E, Miech EJ, Williams LS, Arling G. Vascular Risk Factor Control in the Year After Ischemic Stroke Versus Myocardial Infarction. [Abstract]. Stroke; A Journal of Cerebral Circulation. 2015 Apr 1; 46(4):A121.
Background: The Veterans Health Administration has multiple quality improvement activities directed at improving vascular risk factor control. We sought to examine facility quality of blood pressure (BP) control ( < 140/90 mm Hg), lipid control (LDL-cholesterol < 100 mg/dL) and glycemic control (HbA1c < 9%) in the one-year after hospitalization for ischemic stroke or acute myocardial infarction (AMI).
Methods: We assembled a retrospective cohort of patients hospitalized with stroke or AMI (fiscal year 2011). Facilities were included if they admitted 25 stroke patients and 25 AMI patients. A facility-level consolidated measure of vascular risk factor control was calculated for the 3 processes of care (number of passes divided by number of opportunities).
Results: A total of 2432 patients had a new stroke and 4873 had a new primary AMI (at 75 facilities). Stroke patients had worse vascular risk factor control than AMI patients (mean facility rate on consolidated measure: stroke, 70% [95%CI 0.68-0.72] vs AMI, 77% [0.75-0.78]). The greatest disparity between stroke and AMI patients was in hypertension control: at 87% of hospitals, fewer stroke patients achieved BP control than AMI patients (mean facility pass rate: stroke, 41% vs AMI, 52%; p < 0.0001). Overall there were no statistical differences for stroke versus AMI patients in facility-level hyperlipidemia control (71% vs 73%, p = 0.33) and glycemic control (79% versus 82%, p = 0.24). AMI patients had more outpatient visits than stroke patients in the year after discharge [AMI: mean 7.9 visits (standard deviation 6.1)]; stroke: mean 6.0 visits (standard deviation 4.5; p < 0.0001].); the primary difference in outpatient utilization was additional cardiology visits for AMI patients (2.5 visits with cardiology per AMI patient vs 0.4 visits per stroke patient; p < 0.001).
Conclusions: These results demonstrated clinically substantial disparities in hypertension control among patients with stroke vs patients with AMI. It may be that cardiologists provided risk factor management to AMI patients that stroke patients did not receive. The etiology of these observed differences merits additional investigation.