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Coronary Heart Disease Screening: Are Ischemic Stroke Patients Receiving Guideline Concordant Care?

Sico JJ, Myers L, Williams LS, Bravata DM. Coronary Heart Disease Screening: Are Ischemic Stroke Patients Receiving Guideline Concordant Care? Poster session presented at: American Neurological Association Annual Meeting; 2014 Oct 12; Baltimore, MD.


Introduction: Current guidelines recommend screening for coronary heart disease (CHD) using cardiac stress testing for ischemic stroke patients at 'high risk' of future cardiac events. However, it is unknown whether high risk stroke patients routinely receive guideline concordant cardiac stress testing. Methods: Medical records were abstracted for a sample of 3965 Veterans from 131 Veterans Health Administration (VHA) facilities who were admitted for a confirmed diagnosis of ischemic stroke (fiscal year 2007). Patients with a history of CHD, receipt of cardiac stress testing within 18-months prior to stroke event, and patients who died during the index hospitalization were excluded (n = 1628). Framingham Risk Scores (FRS) were calculated on the basis of: age, gender, systolic blood pressure, blood pressure treatment (yes/no), smoking status (smoker/non-smoker), diabetes, total cholesterol, and high-density lipoprotein cholesterol. FRS 20 was used to define patients at "high-risk" of CHD. Administrative data were used to determine whether or not cardiac stress testing was performed within 6-months following discharge from the index stroke hospitalization. Logistic regression was used to assess whether cardiac stress testing was performed more frequently among high risk stroke patients. Results: Among 2337 stroke patients, 28% (n = 664) had FRS 20, and a total of 6% (n = 140) had cardiac stress testing within 6-months of discharge. Cardiac stress testing was not more frequently performed among those with 'high risk' (5.6%) than those with 'low risk' (6.2%) FRS. High risk patients (FRS 20) were as likely to have received cardiac stress testing as those with low FRS (OR = 0.90; CI95: 0.61-1.32). Conclusions: Guideline concordant cardiac screening is underutilized among ischemic stroke patients without evidence of previous cardiac stress testing. Patients at the highest risk of future cardiac events were not more likely to receive cardiac stress testing than patients with lower risk. Additional research is required to identify potential barriers to CHD screening, and to determine whether outcomes are improved among patients who received CHD screening.

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