Published online before print May 25, 2006, doi: 10.1161/01.STR.0000226463.17988.a3
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(Stroke. 2006;37:1844.)
© 2006 American Heart Association, Inc.
Original Contributions |
Quality of Hospital and Outpatient Care After Stroke or Transient Ischemic Attack
Insights From a Stroke Survey in The Netherlands
From the Erasmus Medical Center, Department of Cardiology, Rotterdam, The Netherlands (W.J.M.S.o.R., S.H., M.L.S.); the Erasmus Medical Center, Department of Neurology, Rotterdam, The Netherlands (D.W.J.D.); the Atrium Medical Center, Department of Neurology, Heerlen, The Netherlands (C.L.F.); the University Hospital Maastricht, Department of Neurology, Maastricht, The Netherlands (R.J.v.O.); and ISALA Klinieken, Department of Neurology, Zwolle, The Netherlands (G.d.J.).
Correspondence to Wilma J.M. Scholte op Reimer, RN, PhD, Erasmus MC, Department of Cardiology, Room Ba561, PO Box 2040, 3000 CA Rotterdam, The Netherlands. E-mail w.scholteopreimer{at}erasmusmc.nl
Background and Purpose— Limited data are available on management of outpatients with stroke or transient ischemic attack (TIA) and on clinicians’ reasons for withholding procedures recommended by guidelines. We assessed to what extent guidelines are appropriately applied after ischemic stroke or TIA, in admitted patients as well as outpatients.
Methods— A survey was conducted in 11 centers in the Netherlands, which prospectively enrolled 579 admitted patients and 393 outpatients. Data were collected by trained research assistants. Duplicate assessment in 10% of patients showed good agreement with neurologists (median 
=0.86). Treating neurologists were asked to provide arguments for withholding recommended procedures in eligible patients.
Results— Recommended acute procedures were provided in the majority of admitted patients, but less often in outpatients: brain imaging (98% and 93%, respectively), 12-lead ECG (96% and 81%), laboratory tests (97% and 86%), aspirin within 48 hours (90% and 68% of eligible patients). Secondary preventive measures were not always taken in both eligible inpatients and eligible outpatients: carotid endarterectomy (provided in 31% and 30% of patients), antiplatelet agents (93% and 90%), oral anticoagulants (60% and 48%), antihypertensive agents (57% and 44%), and cholesterol-lowering therapy (71% and 52%). Reasons for withholding recommended procedures were plausible for almost all admitted patients, but were unclear in the majority of outpatients.
Conclusions— Compared with other national stroke surveys, we found high-quality acute care in admitted ischemic stroke patients, whereas secondary prevention was comparably poor. Although the majority of our centers have rapid-access TIA clinics, there is still substantial potential to improve quality of stroke care in outpatients.
Key Words: ischemia • Quality assurance • transient ischemic attack
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