Comparison of Risk Factor Control in the Year After Discharge for Ischemic Stroke Versus Acute Myocardial Infarction

Dawn Bravata, Joanne Daggy, Jared Brosch, Jason J. Sico, Fitsum Baye, Laura J. Myers, Christianne L. Roumie, Eric Cheng, Jessica Coffing, Gregory Arling

Research output: Contribution to journalArticle

5 Citations (Scopus)

Abstract

BACKGROUND AND PURPOSE: The Veterans Health Administration has engaged in quality improvement to improve vascular risk factor control. We sought to examine blood pressure (<140/90 mm Hg), lipid (LDL [low-density lipoprotein] cholesterol <100 mg/dL), and glycemic control (hemoglobin A1c <9%), in the year post-hospitalization for acute ischemic stroke or acute myocardial infarction (AMI).

METHODS: We identified patients who were hospitalized (fiscal year 2011) with ischemic stroke, AMI, congestive heart failure, transient ischemic attack, or pneumonia/chronic obstructive pulmonary disease. The primary analysis compared risk factor control after incident ischemic stroke versus AMI. Facilities were included if they cared for ≥25 ischemic stroke and ≥25 AMI patients. A generalized linear mixed model including patient- and facility-level covariates compared risk factor control across diagnoses.

RESULTS: Forty thousand two hundred thirty patients were hospitalized (n=75 facilities): 2127 with incident ischemic stroke and 4169 with incident AMI. Fewer stroke patients achieved blood pressure control than AMI patients (64%; 95% confidence interval, 0.62-0.67 versus 77%; 95% confidence interval, 0.75-0.78; P<0.0001). After adjusting for patient and facility covariates, the odds of blood pressure control were still higher for AMI than ischemic stroke patients (odds ratio, 1.39; 95% confidence interval, 1.21-1.51). There were no statistical differences for AMI versus stroke patients in hyperlipidemia (P=0.534). Among patients with diabetes mellitus, the odds of glycemic control were lower for AMI than ischemic stroke patients (odds ratio, 0.72; 95% confidence interval, 0.54-0.96).

CONCLUSIONS: Given that hypertension control is a cornerstone of stroke prevention, interventions to improve poststroke hypertension management are needed.

Original languageEnglish (US)
Pages (from-to)296-303
Number of pages8
JournalStroke
Volume49
Issue number2
DOIs
StatePublished - Feb 1 2018

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Stroke
Myocardial Infarction
Confidence Intervals
Blood Pressure
Odds Ratio
Hypertension
Veterans Health
United States Department of Veterans Affairs
Transient Ischemic Attack
Quality Improvement
Hyperlipidemias
LDL Cholesterol
Chronic Obstructive Pulmonary Disease
Linear Models
Pneumonia
Diabetes Mellitus
Hemoglobins
Hospitalization
Heart Failure
Lipids

Keywords

  • diabetes mellitus
  • hyperlipidemia
  • hypertension
  • myocardial infarction
  • risk factors

ASJC Scopus subject areas

  • Clinical Neurology
  • Cardiology and Cardiovascular Medicine
  • Advanced and Specialized Nursing

Cite this

Comparison of Risk Factor Control in the Year After Discharge for Ischemic Stroke Versus Acute Myocardial Infarction. / Bravata, Dawn; Daggy, Joanne; Brosch, Jared; Sico, Jason J.; Baye, Fitsum; Myers, Laura J.; Roumie, Christianne L.; Cheng, Eric; Coffing, Jessica; Arling, Gregory.

In: Stroke, Vol. 49, No. 2, 01.02.2018, p. 296-303.

Research output: Contribution to journalArticle

Bravata, Dawn ; Daggy, Joanne ; Brosch, Jared ; Sico, Jason J. ; Baye, Fitsum ; Myers, Laura J. ; Roumie, Christianne L. ; Cheng, Eric ; Coffing, Jessica ; Arling, Gregory. / Comparison of Risk Factor Control in the Year After Discharge for Ischemic Stroke Versus Acute Myocardial Infarction. In: Stroke. 2018 ; Vol. 49, No. 2. pp. 296-303.
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