Adherence to American Heart Association/American Stroke Association Clinical Performance Measures in a Peruvian Neurological Reference Institute

Abstract

There is little knowledge of adherence to American Heart Association/American Stroke Association (AHA/ASA) stroke performance measures in developing countries like Peru. The objectives of this study were to assess the percentage of adherence to AHA/ASA stroke performance measures and to determine the effect of local demographic variables and risk factors on adherence to the AHA/ASA stroke performance measures at the Neurological Institute of Neurological Science, a reference center for neurological diseases in Lima, Peru. We examined a sample size of 150 patients with stroke, from a population of 734, admitted between 2014 and 2016. Only 5 of 15 AHA/ASA stroke performance measures were accomplished more or equal to 85% of the time (accepted by Joint Commission for Hospital Accreditation): antithrombotic treatment at discharge (94.63%), antithrombotic treatment within 2 days of hospitalization (93.33%), discharge on statins (99.32%), rehabilitation assessment (90.67%) and cardiac monitoring within 2 hours of arrival and continuing for 24 hours during hospitalization (97.31%). The mean composite measure was 47.21%, far from the minimum percentage required for accreditation (>= 85%). After adjusting for all significant variables, we obtained the following results: stroke patients who were married had a four times higher probability of good adherence than those who were single (95% CI: 1.01-11.81, p-value=0.047) and patients who had a delay from onset of stroke to arrival at the hospital of more than 4.5 hours had 73% lower probability of receiving appropriate stroke performance measures compared to those who had a delay from onset to arrival of ≤4.5hours and those who had an National Institutes of Health Stroke Scale (NIHSS) score ≥ 13 had 90% lower probability of receiving appropriate stroke performance measures compared to those with an NIHSS of 4. Conclusion: The mean composite measure was 47.21%, far from the minimum good quality required for accreditation (>= 85%). After adjusting for all significant variables, we obtained statistical significance for the following results: married patients had a higher probability of receiving appropriate stroke performance measures and those who had an onset to arrival time > 4.5 hours and those who had an NIHSS score >= 13 had lower probability of receiving appropriate stroke performance measures.