1. Adherence to Clinical Practice Treatment Guidelines for Acute Ischemic
Stroke in a Central Indiana Hospital
Storm Van Wey, Pharm.D. Candidate, Kevin Tuohy, Pharm.D., BCPS
Butler University College of Pharmacy and Health Sciences, Indianapolis, Indiana
IU Health Methodist Hospital, Indianapolis, Indiana
Background
• An ischemic stroke is a medical condition defined as an
acute attack on mental ability caused by a lack of cranial
blood flow that may lead to long-term disability.
• 795,000 people have strokes every year; 185,000 of
which are recurrent attacks in individuals with prior
strokes. 130,000 people die from strokes every year,
equating to one death every 4 minutes as a result of
stroke.
• Stroke is the fourth leading cause of death in Indiana,
contributing to 3082 deaths in 2010.
Study Objective
To evaluate the adherence of IU Health Methodist Hospital,
in Indianapolis, IN, to the latest AHA/ASA stroke treatment
guidelines and analyze any discrepancies.
Methods
• Stroke Facts. Centers for Disease Control and Prevention:
http://www.cdc.gov/stroke/facts.htm. March 25, 2015. Accessed:
August 10, 2016
• Indiana State Fact Sheet. American Heart Association/American
Stroke Association: https://www.heart.org/idc/groups/heart-
public/@wcm/@adv/documents/downloadable/ucm_307172.pdf.
Accessed: August 10, 2016.
• Jauch EC, Saver JL, Adams Jr. HP, et al. Guidelines for the early
management of patients with acute ischemic stroke. J Am Heart
Assoc. 2013;44:870-947.
• Powers WJ, Derdeyn CP, Biller J, et al. 2015 American Heart
Association/American Stroke Association focused update of the
2013 guidelines for the early management of patients with acute
ischemic stroke regarding endovascular treatment. J Am Heart
Assoc. 2015;46:3020-3035.
• Kernan WN, Ovbiage B, Black HR, et al. Guidelines for the
prevention of stroke in patients with stroke and transient ischemic
attack. J Am Heart Assoc. 2014;45:2160-2236.
• Lansberg MG, O’Donnell MJ, Khatri P, et al. Antithrombotic
therapy and prevention of thrombosis, 9th ed. Chest.
2012;141:(2_suppl):e601S-e636S.
References
Exclusion Criteria
• Patient Age <18 years of age
• Hemorrhagic Stroke
Data Collection Sheet
• This study will be a retrospective electronic medical record
review at IU Health Methodist Hospital.
• Patients with diagnosis of acute ischemic stroke from July 1,
2015 through June 30, 2016 (up to a maximum of 100
individuals) will be included in this study.
• All patients will be followed until discharge or death.
• The following inpatient data will be collected for each
patient:
o tPA administration
o Aspirin administration
o High intensity statin initiation, or documentation of
contraindication
o Monitoring and adjustment of blood pressure
o Regulation of blood sugar
o Administration of medications for deep vein thrombosis
prophylaxis
• Discharge instructions will be evaluated, and the following
data will be collected for each patient:
o Prescription or plan for aspirin
o Prescription or plan for statin
o Plan for blood pressure follow up and appropriate
prescriptions
• Descriptive statistics will be used to analyze all collected
data in order to determine level of adherence to stroke
guidelines as set forth by the AHA/ASA
Literature Review
• The are treatment guidelines are published by the American
Heart Association and American Stroke Association
(AHA/ASA).
o The first guideline, published January 2013, with an
update in 2015 outlines the appropriate care for and
acute stroke. Topics include administration of tPa and
aspirin, and monitoring and adjustment of blood
pressure and blood sugar.
o The second guideline, published May 2014, outlines the
appropriate care for prevention of stroke in patients
with a history of stroke. Topics include appropriate
prescribing for aspirin, statins, and blood pressure.
• The CHEST guidelines provide appropriate therapy
recommendations for VTE prophylaxis in the setting of acute
stroke treatment.