Adherence to an integrated care pathway for stroke is associated with lower risk of major cardiovascular events: A report from the Athens Stroke Registry.

Sagris, Dimitrios ORCID: 0000-0001-6657-5665, Lip, Gregory ΥΗ ORCID: 0000-0002-7566-1626, Korompoki, Eleni, Ntaios, George and Vemmos, Konstantinos (2024) Adherence to an integrated care pathway for stroke is associated with lower risk of major cardiovascular events: A report from the Athens Stroke Registry. European journal of internal medicine, 122. pp. 61-67.

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Official URL: http://dx.doi.org/10.1016/j.ejim.2023.12.010

Abstract

<h4>Background</h4>A recent European Society of Cardiology (ESC) Council on Stroke position paper proposed a holistic integrated care management approach for stroke patients, to improve cardiovascular outcomes. The impact of implementing the ABC<sub>stroke</sub> pathway 'concept' on clinical outcomes has never been estimated before. In order to investigate the potential effect of ABC<sub>stroke</sub> pathway adherence to cardiovascular outcomes post stroke, we performed a post-hoc analysis from the Athens Stroke Registry.<h4>Methods and results</h4>This analysis was performed in the Athens Stroke Registry, which includes all consecutive patients with acute first-ever ischemic stroke. The Kaplan-Meier product limit was used to estimate the cumulative hazard of each outcome according to adherence with the ABC<sub>stroke</sub> pathway. We studied 2513 patients [median (IQR) age 71 (62-78) years; 37.7 % female] with ischemic stroke with median follow-up period of 30 (6-75) months. Full adherence to the ABC pathway was identified in 156 (6.2 %) of the patients, while 192 (7.6 %) did not adhere to any of the therapeutic pillars of ABC<sub>stroke</sub>. Full adherence to ABC treatment pathway was associated with significant reduction of stroke recurrence, compared to patients with no or partial adherence (aHR: 0.61; 95 %CI: 0.37-0.99), as well as a lower risk of MACE (HR: 0.59; 0.39-0.88) and death (aHR: 0.22; 95 %CI: 0.12-0.41).<h4>Conclusion</h4>Full adherence to the ABC<sub>stroke</sub> pathway based on the current guidelines was evident in only 6.2 % of our ischaemic stroke cohort but was independently associated with lower risks of stroke recurrence, major cardiovascular events and mortality. This highlights a potential opportunity to improve clinical outcomes post-stroke with a holistic or integrated care management approach.

Item Type:	Article
Uncontrolled Keywords:	Humans, Brain Ischemia, Registries, Risk Factors, Aged, Delivery of Health Care, Integrated, Female, Male, Stroke, Ischemic Stroke
Divisions:	Faculty of Health and Life Sciences Faculty of Health and Life Sciences > Institute of Life Courses and Medical Sciences
Depositing User:	Symplectic Admin
Date Deposited:	21 Dec 2023 13:34
Last Modified:	14 Apr 2024 22:31
DOI:	10.1016/j.ejim.2023.12.010
Open Access URL:	https://doi.org/10.1016/j.ejim.2023.12.010
Related URLs:	Author Publisher
URI:	https://livrepository.liverpool.ac.uk/id/eprint/3177584