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02-09-2010 | Stroke | Article

GWTG–Stroke model applicable to other countries


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MedWire News: The Get With The Guidelines (GWTG)-Stroke model for quality stroke care may be useful globally, say Taiwanese researchers.

"We looked at whether GWTG-Stroke, which has been successful in improving stroke care in the USA, would be applicable across national and economic boundaries - especially in countries spending much less than the USA in stroke-related care," said lead researcher Chung Hsu (China Medical University, Taichung).

Hsu and team looked at 30,599 stroke admissions recorded between 2006 and 2008 in the Taiwan Stroke Registry (TSR). They note that Taiwan spends about a tenth of what the USA does per new or recurrent stroke.

They discounted two GWTG-Stroke quality indicators: prophylaxis for deep vein thrombosis, as this was rare, occurring in just 0.2% of patients; and smoking cessation advice, which is not covered by national healthcare in Taiwan and therefore could not be validated.

Five performance measures were applicable to the Taiwanese stroke patients, these indicators being thrombolysis within 3 hours, receipt of antithrombotics during hospitalization and at discharge, anticoagulation for patients with atrial fibrillation (AF), and receipt of discharge lipid-lowering agents. One safety measure was also applicable: the rate of symptomatic intracerebral hemorrhage after thrombolysis.

Antithrombotics were given to most patients during hospitalization (94%) and at discharge (86%), the researchers report in the journal Circulation.

These rates were close to those seen in US GWTG-Stroke studies, they note. But rates for the other performance measures were considerably lower, ranging from 9% for thrombolysis to 39% for discharge lipid-lowering therapy.

The performance indicators had a significant impact on patient outcomes, say Hsu et al. The risk for cardiovascular events and death over the next 6 months was reduced by at least half if patients received thrombolysis, discharge antithrombotics, or anticoagulation in the case of AF. Discharge lipid-lowering therapy had no significant impact over this timescale.

This suggests that stroke care in Taiwan needs to be improved, say the researchers.

"An important feature of GWTG-Stroke is its effect on improving the quality of stroke care over time," they note.

"Applying GWTG-Stroke in TSR and registries in other countries is likely to be an effective mechanism for quality improvement."

MedWire ( is an independent clinical news service provided by Current Medicine Group, a trading division of Springer Healthcare Limited. © Springer Healthcare Ltd; 2010

By Eleanor McDermid