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Current Drug Safety

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ISSN (Print): 1574-8863
ISSN (Online): 2212-3911

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Research Article

Management of Acute Stroke Among Lebanese Patients: Assessing Adherence to International Guidelines

Author(s): Diana Malaeb, Sarah Cherri*, Iqbal Fahs, Hala Sacre, Emane Abdallah, Pascale Salameh and Hassan Hosseini

Volume 18, Issue 4, 2023

Published on: 09 January, 2023

Page: [555 - 562] Pages: 8

DOI: 10.2174/1574886318666221118151504

Price: $65

Abstract

Background: Ischemic stroke accounts for around 87% of all strokes worldwide and is the second leading cause of mortality and a significant factor of disability in adults. The objective of this study was to assess the adherence to international treatment guidelines for ischemic stroke in Lebanese hospitals and evaluate factors associated with in-hospital mortality.

Methods: This retrospective observational study was conducted in three Lebanese hospitals between January 2018 and December 2019. All adult patients diagnosed with ischemic stroke and who were subsequently admitted and treated in the internal medicine department, intensive care unit, or coronary care units were included in the study.

Results: Out of 292 patients with stroke, 56.8% were females with hypertension being the most common previous disease (38.4%). Concerning acute management, 94.5% had an early brain imaging performed upon hospital presentation, 14.4% were eligible for emergency reperfusion, 2.1% were prescribed fibrinolytic therapy, 50% were adherent with acute hypertension treatment, and 6.2% were adherent with the antiplatelet regimen recommendation. The results highlight that right sided hemiparesis, decreased level of consciousness, and hyperthermia (T > 38°C) were significantly associated with in-hospital death. Guideline adherence for all the acute treatment measures and management strategies was 90.2%.

Conclusion: The study highlights that guideline recommendations were not uniformly applied among all patients, and those recommendation standards set by the guidelines were not applied among all hospitals.

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Graphical Abstract

[1]
Adams HP Jr, Bendixen BH, Kappelle LJ, et al. Classification of subtype of acute ischemic stroke. Definitions for use in a multicenter clinical trial. TOAST. Trial of Org 10172 in Acute Stroke Treatment. Stroke 1993; 24(1): 35-41.
[http://dx.doi.org/10.1161/01.STR.24.1.35] [PMID: 7678184]
[2]
Sacco RL, Kasner SE, Broderick JP, et al. An updated definition of stroke for the 21st century: A statement for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 2013; 44(7): 2064-89.
[http://dx.doi.org/10.1161/STR.0b013e318296aeca] [PMID: 23652265]
[3]
Rosamond W, Flegal K, Furie K, et al. Heart disease and stroke statistics - 2008 update: A report from the American heart association statistics committee and stroke statistics subcommittee. Circulation 2008; 117(4): e25-e146.
[PMID: 18086926]
[4]
Feigin VL, Forouzanfar MH, Krishnamurthi R, et al. Global and regional burden of stroke during 1990-2010: Findings from the global burden of disease study 2010. Lancet 2014; 383(9913): 245-55.
[http://dx.doi.org/10.1016/S0140-6736(13)61953-4] [PMID: 24449944]
[5]
Lahoud N, Salameh P, Saleh N, Hosseini H. Prevalence of Lebanese stroke survivors: A comparative pilot study. J Epidemiol Glob Health 2015; 6(3): 169-76.
[http://dx.doi.org/10.1016/j.jegh.2015.10.001] [PMID: 26599284]
[6]
Abdo R, Abboud H, Salameh P, El Hajj T, Hosseini H. Mortality and predictors of death poststroke: data from a multicenter prospective cohort of lebanese stroke patients. J Stroke Cerebrovasc Dis 2019; 28(4): 859-68.
[http://dx.doi.org/10.1016/j.jstrokecerebrovasdis.2018.11.033] [PMID: 30638943]
[7]
Ingeman A, Andersen G, Hundborg HH, Svendsen ML, Johnsen SP. In-hospital medical complications, length of stay, and mortality among stroke unit patients. Stroke 2011; 42(11): 3214-8.
[http://dx.doi.org/10.1161/STROKEAHA.110.610881] [PMID: 21868737]
[8]
Johnston KC, Li JY, Lyden PD, et al. Medical and neurological complications of ischemic stroke: Experience from the RANTTAS trial. Stroke 1998; 29(2): 447-53.
[http://dx.doi.org/10.1161/01.STR.29.2.447] [PMID: 9472888]
[9]
Indredavik B, Rohweder G, Naalsund E, Lydersen S. Medical complications in a comprehensive stroke unit and an early supported discharge service. Stroke 2008; 39(2): 414-20.
[http://dx.doi.org/10.1161/STROKEAHA.107.489294] [PMID: 18096834]
[10]
Hong KS, Kang DW, Koo JS, et al. Impact of neurological and medical complications on 3-month outcomes in acute ischaemic stroke. Eur J Neurol 2008; 15(12): 1324-31.
[http://dx.doi.org/10.1111/j.1468-1331.2008.02310.x] [PMID: 19049549]
[11]
Langhorne P, Stott DJ, Robertson L, et al. Medical complications after stroke: A multicenter study. Stroke 2000; 31(6): 1223-9.
[http://dx.doi.org/10.1161/01.STR.31.6.1223] [PMID: 10835436]
[12]
Bovim MR, Askim T, Lydersen S, Fjærtoft H, Indredavik B. Complications in the first week after stroke: A 10-year comparison. BMC Neurol 2016; 16(1): 133.
[http://dx.doi.org/10.1186/s12883-016-0654-8] [PMID: 27515730]
[13]
Wang Y, Wu D, Wang Y, Ma R, Wang C, Zhao W. A survey on adherence to secondary ischemic stroke prevention. Neurol Res 2006; 28(1): 16-20.
[http://dx.doi.org/10.1179/016164106X91816] [PMID: 16464357]
[14]
Candelise L, Gattinoni M, Bersano A, Micieli G, Sterzi R, Morabito A. Stroke-unit care for acute stroke patients: An observational follow-up study. Lancet 2007; 369(9558): 299-305.
[http://dx.doi.org/10.1016/S0140-6736(07)60152-4] [PMID: 17258670]
[15]
Li CH, Khor GT, Chen CH, Huang P, Lin RT. Potential risk and protective factors for in-hospital mortality in hyperacute ischemic stroke patients. Kaohsiung J Med Sci 2008; 24(4): 190-6.
[http://dx.doi.org/10.1016/S1607-551X(08)70116-5] [PMID: 18424355]
[16]
Luker J, Grimmer-Somers K. Factors influencing acute stroke guideline compliance: A peek inside the ‘black box’ for allied health staff. J Eval Clin Pract 2009; 15(2): 383-9.
[http://dx.doi.org/10.1111/j.1365-2753.2008.01023.x] [PMID: 19335501]
[17]
Powers WJ, Rabinstein AA, Ackerson T, et al. Guidelines for the early management of patients with acute ischemic stroke: 2019 Update to the 2018 guidelines for the early management of acute ischemic stroke: A guideline for healthcare professionals from the American heart association/American stroke association. stroke 2019; 50(12): e344-418.
[http://dx.doi.org/10.1161/STR.0000000000000211] [PMID: 31662037]
[18]
Grol R. Successes and failures in the implementation of evidence-based guidelines for clinical practice. Med Care 2001; 39(8): 46-54.
[http://dx.doi.org/10.1097/00005650-200108002-00003] [PMID: 11583121]
[19]
Buchan H. Gaps between best evidence and practice: Causes for concern. Med J Aust 2004; 180(S6): S48-9.
[http://dx.doi.org/10.5694/j.1326-5377.2004.tb05944.x] [PMID: 15012579]
[20]
Hubbard I, Wass S, Pepper E. Stroke in older survivors of ischemic stroke: Standard care or something different? Geriatrics 2017; 2(2): 18.
[http://dx.doi.org/10.3390/geriatrics2020018] [PMID: 31011028]
[21]
Reeves M, Bhatt A, Jajou P, Brown M, Lisabeth L. Sex differences in the use of intravenous rt-PA thrombolysis treatment for acute ischemic stroke: A meta-analysis. Stroke 2009; 40(5): 1743-9.
[http://dx.doi.org/10.1161/STROKEAHA.108.543181] [PMID: 19228855]
[22]
Wiedmann S, Hillmann S, Abilleira S, et al. Variations in acute hospital stroke care and factors influencing adherence to quality indicators in 6 European audits. Stroke 2015; 46(2): 579-81.
[http://dx.doi.org/10.1161/STROKEAHA.114.007504] [PMID: 25550369]
[23]
Dippel DWJ, Simoons ML. Improving adherence to guidelines for acute stroke management. Circulation 2009; 119(1): 16-8.
[http://dx.doi.org/10.1161/CIRCULATIONAHA.108.821470] [PMID: 19103985]
[24]
Serrano-Villar S, Fresco G, Ruiz-Artacho P, et al. Stroke in the very old: Myths and realities. Med Clin 2013; 140(2): 53-8.
[http://dx.doi.org/10.1016/j.medcli.2012.05.036] [PMID: 22985865]
[25]
Denti L, Scoditti U, Tonelli C, et al. The poor outcome of ischemic stroke in very old people: A cohort study of its determinants. J Am Geriatr Soc 2010; 58(1): 12-7.
[http://dx.doi.org/10.1111/j.1532-5415.2009.02616.x] [PMID: 20002511]
[26]
Forti P, Maioli F, Procaccianti G, et al. Independent predictors of ischemic stroke in the elderly: Prospective data from a stroke unit. Neurology 2013; 80(1): 29-38.
[http://dx.doi.org/10.1212/WNL.0b013e31827b1a41] [PMID: 23243075]
[27]
Soares I, Abecasis P, Ferro JM. Outcome of first-ever acute ischemic stroke in the elderly. Arch Gerontol Geriatr 2011; 53(2): e81-7.
[http://dx.doi.org/10.1016/j.archger.2010.06.019] [PMID: 20688404]
[28]
Sweileh WM, Sawalha AF, Al-Aqad SM, Zyoud SH, Al-Jabi SW. Predictors of in-hospital mortality after acute stroke: Impact of gender. Int J Clin Exp Med 2009; 2(1): 41-7.
[PMID: 19436831]
[29]
Malaeb D, Cherri S, Hallit S, Saade S, Hosseini H, Salameh P. Assessment of post discharge medication prescription among Lebanese patients with cerebral infarction: Results of a cross-sectional study. Clin Neurol Neurosurg 2020; 191: 105674.
[http://dx.doi.org/10.1016/j.clineuro.2020.105674] [PMID: 31954365]
[30]
Molina CA, Saver JL. Extending reperfusion therapy for acute ischemic stroke: Emerging pharmacological, mechanical, and imaging strategies. Stroke 2005; 36(10): 2311-20.
[http://dx.doi.org/10.1161/01.STR.0000182100.65262.46] [PMID: 16179577]
[31]
Kamalian S, Lev MH. Stroke imaging. Radiol Clin North Am 2019; 57(4): 717-32.
[http://dx.doi.org/10.1016/j.rcl.2019.02.001] [PMID: 31076028]
[32]
Burton KR, Kapral MK, Li S, et al. Predictors of diagnostic neuroimaging delays among adults presenting with symptoms suggestive of acute stroke in Ontario: A prospective cohort study. CMAJ Open 2016; 4(2): E331-7.
[http://dx.doi.org/10.9778/cmajo.20150110] [PMID: 27398382]
[33]
Kelly AG, Hellkamp AS, Olson D, Smith EE, Schwamm LH. Predictors of rapid brain imaging in acute stroke: Analysis of the get with the guidelines-stroke program. Stroke 2012; 43(5): 1279-84.
[http://dx.doi.org/10.1161/STROKEAHA.111.626374] [PMID: 22442169]
[34]
Hacke W, Donnan G, Fieschi C, et al. Association of outcome with early stroke treatment: Pooled analysis of ATLANTIS, ECASS, and NINDS rt-PA stroke trials. Lancet 2004; 363(9411): 768-74.
[http://dx.doi.org/10.1016/S0140-6736(04)15692-4] [PMID: 15016487]
[35]
Lees KR, Bluhmki E, von Kummer R, et al. Time to treatment with intravenous alteplase and outcome in stroke: An updated pooled analysis of ECASS, ATLANTIS, NINDS, and EPITHET trials. Lancet 2010; 375(9727): 1695-703.
[http://dx.doi.org/10.1016/S0140-6736(10)60491-6] [PMID: 20472172]
[36]
Balami JS, Hadley G, Sutherland BA, Karbalai H, Buchan AM. The exact science of stroke thrombolysis and the quiet art of patient selection. Brain 2013; 136(12): 3528-53.
[http://dx.doi.org/10.1093/brain/awt201] [PMID: 24038074]
[37]
Fisher M, Albers GW. Advanced imaging to extend the therapeutic time window of acute ischemic stroke. Ann Neurol 2013; 73(1): 4-9.
[http://dx.doi.org/10.1002/ana.23744] [PMID: 23378323]
[38]
Sandhu GS, Sunshine JL. Advanced neuroimaging to guide acute stroke therapy. Curr Cardiol Rep 2012; 14(6): 741-53.
[http://dx.doi.org/10.1007/s11886-012-0315-5] [PMID: 23001815]
[39]
Ishitsuka K, Kamouchi M, Hata J, et al. High blood pressure after acute ischemic stroke is associated with poor clinical outcomes: Fukuoka Stroke Registry. Hypertension 2014; 63(1): 54-60.
[http://dx.doi.org/10.1161/HYPERTENSIONAHA.113.02189] [PMID: 24126175]
[40]
Yong M, Kaste M. Association of characteristics of blood pressure profiles and stroke outcomes in the ECASS-II trial. Stroke 2008; 39(2): 366-72.
[http://dx.doi.org/10.1161/STROKEAHA.107.492330] [PMID: 18096843]
[41]
Stead LG, Gilmore RM, Decker WW, Weaver AL, Brown RD Jr. Initial emergency department blood pressure as predictor of survival after acute ischemic stroke. Neurology 2005; 65(8): 1179-83.
[http://dx.doi.org/10.1212/01.wnl.0000180939.24845.22] [PMID: 16247043]
[42]
Grise EM, Adeoye O, Lindsell C, et al. Emergency department adherence to American Heart Association guidelines for blood pressure management in acute ischemic stroke. Stroke 2012; 43(2): 557-9.
[http://dx.doi.org/10.1161/STROKEAHA.111.637983] [PMID: 22033993]
[43]
Martin-Schild S, Hallevi H, Albright KC, et al. Aggressive blood pressure-lowering treatment before intravenous tissue plasminogen activator therapy in acute ischemic stroke. Arch Neurol 2008; 65(9): 1174-8.
[http://dx.doi.org/10.1001/archneur.65.9.1174] [PMID: 18779419]
[44]
Venkat P, Chopp M, Chen J. Blood–brain barrier disruption, vascular impairment, and ischemia/reperfusion damage in diabetic stroke. J Am Heart Assoc 2017; 6(6): e005819.
[http://dx.doi.org/10.1161/JAHA.117.005819] [PMID: 28572280]
[45]
Yong M, Kaste M. Dynamic of hyperglycemia as a predictor of stroke outcome in the ECASS-II trial. Stroke 2008; 39(10): 2749-55.
[http://dx.doi.org/10.1161/STROKEAHA.108.514307] [PMID: 18703813]
[46]
Alexandrov AW, Palazzo P, Biby S, et al. Back to basics: Adherence with guidelines for glucose and temperature control in an american comprehensive stroke center sample. J Neurosci Nurs 2018; 50(3): 131-7.
[http://dx.doi.org/10.1097/JNN.0000000000000358] [PMID: 29621071]
[47]
Greer DM, Funk SE, Reaven NL, Ouzounelli M, Uman GC. Impact of fever on outcome in patients with stroke and neurologic injury: A comprehensive meta-analysis. Stroke 2008; 39(11): 3029-35.
[http://dx.doi.org/10.1161/STROKEAHA.108.521583] [PMID: 18723420]
[48]
Diringer MN, Reaven NL, Funk SE, Uman GC. Elevated body temperature independently contributes to increased length of stay in neurologic intensive care unit patients. Crit Care Med 2004; 32(7): 1489-95.
[http://dx.doi.org/10.1097/01.CCM.0000129484.61912.84] [PMID: 15241093]
[49]
Middleton S, McElduff P, Ward J, et al. Implementation of evidence-based treatment protocols to manage fever, hyperglycaemia, and swallowing dysfunction in acute stroke (QASC): A cluster randomised controlled trial. Lancet 2011; 378(9804): 1699-706.
[http://dx.doi.org/10.1016/S0140-6736(11)61485-2] [PMID: 21996470]
[50]
Fekadu G, Chelkeba L, Melaku T, et al. Management protocols and encountered complications among stroke patients admitted to stroke unit of Jimma university medical center, Southwest Ethiopia: Prospective observational study. Ann Med Surg 2019; 48: 135-43.
[http://dx.doi.org/10.1016/j.amsu.2019.11.003] [PMID: 31788240]
[51]
Temesgen TG, Teshome B, Njogu P. Treatment outcomes and associated factors among hospitalized stroke patients at Shashemene Referral Hospital, Ethiopia. Stroke Res Treat 2018; 2018: 8079578.
[http://dx.doi.org/10.1155/2018/8079578] [PMID: 30228857]
[52]
Bennour A, Ehmoda F, Bo-Shaala S. Clinical characteristics, management and outcome of patients admitted with acute stroke in Benghazi, Libya. IJMBS 2014; 6(4): 159-67.
[http://dx.doi.org/10.4103/1947-489X.210378]
[53]
Li J, Wang D, Tao W, et al. Early consciousness disorder in acute ischemic stroke: Incidence, risk factors and outcome. BMC Neurol 2016; 16(1): 140.
[http://dx.doi.org/10.1186/s12883-016-0666-4] [PMID: 27535026]
[54]
Wang Y, Lim LLY, Levi C, Heller RF, Fisher J. Influence of admission body temperature on stroke mortality. Stroke 2000; 31(2): 404-9.
[http://dx.doi.org/10.1161/01.STR.31.2.404] [PMID: 10657413]

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