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Patterns of care quality and prognosis among hospitalized ischemic stroke patients with chronic kidney disease.

Publication ,  Journal Article
Ovbiagele, B; Schwamm, LH; Smith, EE; Grau-Sepulveda, MV; Saver, JL; Bhatt, DL; Hernandez, AF; Peterson, ED; Fonarow, GC
Published in: J Am Heart Assoc
June 5, 2014

BACKGROUND: Relatively little is known about the quality of care and outcomes for hospitalized ischemic stroke patients with chronic kidney disease (CKD). We examined quality of care and in-hospital prognoses among patients with CKD in the Get With The Guidelines-Stroke (GWTG-Stroke) program METHODS AND RESULTS: We analyzed 679 827 patients hospitalized with ischemic stroke from 1564 US centers participating in the GWTG-Stroke program between January 2009 and December 2012. Use of 7 predefined ischemic stroke performance measures, composite "defect-free" care compliance, and in-hospital mortality were examined based on glomerular filtration rate (GFR) categorized as a dichotomous (+CKD as <60) or rank-ordered variable: normal (≥ 90), mild (≥ 60 to <90), moderate (≥ 30 to <60), severe (≥ 15 to <30), and kidney failure (<15 or dialysis). There were 236 662 (35%) ischemic stroke patients with CKD. Patients with severe renal dysfunction or failure were significantly less likely to receive guideline-based therapies. Compared with patients with normal kidney function (≥ 90), those with CKD (adjusted OR 0.91 [95% CI: 0.89 to 0.92]), moderate dysfunction (adjusted OR 0.94 [95% CI: 0.92 to 0.97]), severe dysfunction (adjusted OR 0.80 [95% CI: 0.77 to 0.84]), or failure (adjusted OR 0.72 [95% CI: 0.68 to 0.0.76]), were less likely to receive 100% defect-free care measure compliance. Inpatient mortality was higher for patients with CKD (adjusted odds ratio 1.44 [95% CI: 1.40 to 1.47]), and progressively rose with more severe renal dysfunction. CONCLUSIONS: Despite higher in-hospital mortality rates, ischemic stroke patients with CKD, especially those with greater severity of renal dysfunction, were less likely to receive important guideline-recommended therapies.

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Published In

J Am Heart Assoc

DOI

EISSN

2047-9980

Publication Date

June 5, 2014

Volume

3

Issue

3

Start / End Page

e000905

Location

England

Related Subject Headings

  • Young Adult
  • United States
  • Stroke
  • Renal Insufficiency, Chronic
  • Quality of Health Care
  • Prognosis
  • Middle Aged
  • Male
  • Humans
  • Hospitals
 

Citation

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Ovbiagele, B., Schwamm, L. H., Smith, E. E., Grau-Sepulveda, M. V., Saver, J. L., Bhatt, D. L., … Fonarow, G. C. (2014). Patterns of care quality and prognosis among hospitalized ischemic stroke patients with chronic kidney disease. J Am Heart Assoc, 3(3), e000905. https://doi.org/10.1161/JAHA.114.000905
Ovbiagele, Bruce, Lee H. Schwamm, Eric E. Smith, Maria V. Grau-Sepulveda, Jeffrey L. Saver, Deepak L. Bhatt, Adrian F. Hernandez, Eric D. Peterson, and Gregg C. Fonarow. “Patterns of care quality and prognosis among hospitalized ischemic stroke patients with chronic kidney disease.J Am Heart Assoc 3, no. 3 (June 5, 2014): e000905. https://doi.org/10.1161/JAHA.114.000905.
Ovbiagele B, Schwamm LH, Smith EE, Grau-Sepulveda MV, Saver JL, Bhatt DL, et al. Patterns of care quality and prognosis among hospitalized ischemic stroke patients with chronic kidney disease. J Am Heart Assoc. 2014 Jun 5;3(3):e000905.
Ovbiagele, Bruce, et al. “Patterns of care quality and prognosis among hospitalized ischemic stroke patients with chronic kidney disease.J Am Heart Assoc, vol. 3, no. 3, June 2014, p. e000905. Pubmed, doi:10.1161/JAHA.114.000905.
Ovbiagele B, Schwamm LH, Smith EE, Grau-Sepulveda MV, Saver JL, Bhatt DL, Hernandez AF, Peterson ED, Fonarow GC. Patterns of care quality and prognosis among hospitalized ischemic stroke patients with chronic kidney disease. J Am Heart Assoc. 2014 Jun 5;3(3):e000905.
Journal cover image

Published In

J Am Heart Assoc

DOI

EISSN

2047-9980

Publication Date

June 5, 2014

Volume

3

Issue

3

Start / End Page

e000905

Location

England

Related Subject Headings

  • Young Adult
  • United States
  • Stroke
  • Renal Insufficiency, Chronic
  • Quality of Health Care
  • Prognosis
  • Middle Aged
  • Male
  • Humans
  • Hospitals