Abstract WP313: Quality of Ischemic Stroke-related Care in Patients With Chronic Kidney Disease (CKD) on Dialysis: Findings From Get With the Guidelines-stroke
Objectives: To assess the quality of ischemic stroke-related care based on American Heart Association (AHA) Get With The Guidelines (GWTG)-Stroke metrics for patients receiving dialysis compared to those with less severe or no CKD .
Methods: The analysis is based on data from 232,236 Medicare-eligible fee-for-service patients admitted to 1581 GWTG-Stroke participating hospitals between January 2009 and December 2012. GFR was determined based on the MDRD study equation. Patients receiving dialysis were identified by ICD-9 diagnosis codes (V45.11 renal dialysis status, 585.6 end stage renal disease, V56.X encounter for dialysis and dialysis catheter care).
Results: Compared to no CKD, dialysis patients received fewer guideline-based therapies (Table). Compared to other CKD stages, dialysis patients less often received VTE prophylaxis, timely treatment with IV-tPA, and defect free care. Treatment with early antithrombotics, discharge on antithrombotics, anticoagulation for atrial fibrillation, and statin use were lowest in patients with CKD stage 5.
Conclusion: Among Medicare beneficiaries with acute ischemic stroke, guideline-adherent care is less frequent in patients on dialysis compared to those with less severe or no CKD. Additional work is needed to determine the reasons for these differences.
Author Disclosures: N. El Husseini: Research Grant; Significant; Research reported in this abstract was supported by the National Institute of Diabetes, digestive and Kidney Diseases of the National Institutes of Health under Award Number P30DK096493. G.C. Fonarow: Research Grant; Significant; PCORI. E.E. Smith: None. C. Ju: None. L.H. Schwamm: Ownership Interest; Modest; LifeImage. Employment; Significant; Medical Director, Mass General TeleHealth. Consultant/Advisory Board; Significant; LifeImage. A.F. Hernandez: None. P. Schulte: None. Y. Xian: None. L.B. Goldstein: None.
- © 2016 by American Heart Association, Inc.