By AMERICAN HEART ASSOCIATION NEWS
A new hospital program in China is expected to give researchers and doctors much-needed information to monitor and improve the evidence-based stroke care of that country’s No. 1 cause of death and severe disability.
The quality improvement program, scheduled to launch this fall, is modeled after the American Heart Association’s Get With The Guidelines-Stroke, a program that helps hospitals improve stroke care and patient outcomes. The American Heart Association/American Stroke Association and Chinese Stroke Association announced the project Saturday in Beijing.
“It is with great excitement that we announce the launch of this collaborative stroke quality improvement project between the CSA and ASA to further enhance cooperation on clinical research, education and the impact of acute stroke science,” Jizong Zhao, president of the Chinese Stroke Association, said in a news release.
The Chinese government has collected information about stroke patients and their care over the past decade. Those efforts will be further enhanced, said U.S.-based researcher and cardiologist Xian Ying, M.D., Ph.D., who is part of the collaboration led by the ASA, the Chinese Stroke Association and Beijing Tiantan Hospital.
The program will provide scientists with coveted data on characteristics, diagnostic testing, treatment, adherence to performance measures and outcomes in stroke patients in China, said Ying, an assistant professor of neurology and medicine at Duke University Medical Center and Duke Clinical Research Institute in Durham, North Carolina.
In addition, the registry will allow hospitals to receive feedback on their performance and gather more reliable statistics for research because “without quality data we cannot monitor what happens in the country, we cannot monitor patterns of care and identify barriers in stroke care,” he said.
Ying said researchers and public health advocates can then use those insights to develop better stroke quality intervention programs in a country that has “a tremendous burden” of stroke. According to recent estimates, stroke killed nearly 2 million people in China in 2013. By comparison, there are an estimated 133,000 U.S. deaths each year from stroke.
Plus, smoking, high blood pressure and atrial fibrillation — all modifiable risk factors for stroke — are more common in China than in the United States.
In working with Chinese colleagues in recent years, “we have observed that the quality of care may not be ideal as compared with what we have seen in the United States, so this project provides the opportunity to facilitate improvements,” Ying said.
For example, he said, acute stroke patients in China are much less likely than U.S. patients to be treated with a widely used clot-busting medication called tPA, or they may have to wait longer to get the drug. That’s important because the benefits of the treatment are highly time-dependent and drug must be given within three to 4.5 hours after the start of stroke symptoms to be effective.
Bin Jiang, M.D., a professor and stroke specialist at the Beijing Neurosurgical Institute at Capital Medical University, said China lacks well-organized stroke care standards. In general, he said healthcare officials and professionals have focused their efforts on improving treatment in dedicated hospital units, with less attention paid to the care patients receive before arriving at a hospital and prevention of additional strokes.
Considering that stroke is largely preventable and that the incidence of stroke in China appears to have increased over the past three decades, “the improvement of fair and available stroke care across urban and rural areas of China is very important — especially to rural residents,” said Jiang, who was not involved in the U.S.-China collaboration.
In a 2016 study, researchers looked at medical records of more than 30,000 stroke patients in China. They found that although there had been “substantial improvement in stroke care quality over time,” Chinese doctors weren’t consistently following treatment guidelines.
Ying said the knowledge gained from Chinese patients will benefit investigators worldwide who can learn from that country’s prevention and treatment strategies.
Ultimately, stroke patients will benefit most, Ying said, because better care translates to better recovery. Improving the treatment and prevention of stroke would also help mitigate the emotional and financial toll the disease can take on family members, said Ying.
“And also, it will help the society because, you know, the cost of stroke is extremely high. Improvement in stroke care quality could ultimately translate into cost savings to the society,” he said.
The program is being supported by Medtronic.