Chinese Guidelines for the Secondary Prevention of Ischemic Stroke and Transient Ischemic Attack 2010

Wang, Yongjun; Zhang, Suming; Zhang, Liqun; Wang, Chunxue; Dong, Qiang; Gao, Shan; Huang, Ruxun; Huang, Yining; Chuanzhen, LV; Liu, Ming; Qin, Haiqiang; Rao, Ming-Li; Xiao, Yi; Xu, Yuming; Yang, Zhi‐gang; Jizuo, Wang; Wang, Wenzhi; Wang, Jie; Wang, Wen‐Juan; Wu, Jiang; Wu, Shengping; Zhao, Xingquan; Zhong, Liyong

doi:10.1111/j.1755-5949.2011.00290.x

Cited by 95 publications

(106 citation statements)

References 51 publications

Supporting

Mentioning

106

Contrasting

Order By: Relevance

“…4 These main interventions of the quality improvement included the establishment of the National Center of Quality Improvement in Stroke Care, the national guidelines for acute treatment and secondary prevention of stroke, organizational stakeholder and opinion leader meetings, hospital recruitment, collaborative workshops for hospital teams, and hospital tool kits. [4][5][6][7][8] These improvement tools were previously shown to be successful in continuously improving the quality of care in the GWTG-Stroke. 12,13 The sensitivity analysis of the 72 hospitals participating in both of 2 phases implied that the sustained participation in the quality improvement initiatives was associated with the better gains.…”

Section: Discussionmentioning

confidence: 99%

“…If stroke patients continue to comply with the prevention measures after discharge, a substantial decline in stroke recurrence may also be predicted according to clinical guidelines. 4,6,21 Additionally, given the enormous number of stroke inpatients each year in China, even superficially modestly increased odds of evidence-based health care will convert into enormously more healthcare opportunities to be implemented. These sustained improvements of the quality of care could translate into enormous cost savings in the long term.…”

Section: Discussionmentioning

confidence: 99%

“…4 This interest has led to several quality management initiatives by the China Ministry of Health after 2008 to promote adherence to guideline-recommended performance measures for acute ischemic stroke. [4][5][6][7][8] We sought to assess the change in the quality of acute ischemic stroke care by comparing the adherence to guideline-recommended performance measures before 2009 with that after the implementation of these initiatives since 2009.…”

Section: Strokementioning

confidence: 99%

“…A total of 13 guideline-recommended performance metrics were prespecified for this study by the Steering Committee based on the national standards, guidelines' recommendations, [6][7][8] and Get With The Guidelines-Stroke (GWTG-Stroke), 12 including 6 acute performance measures: (1) intravenous tissue-type plasminogen activator (tPA) in patients who arrive within 2 hours after symptom onset and treated within 3 hours, (2) antithrombotic medication within 48 hours of admission, (3) deep vein thrombosis prophylaxis within 48 hours of admission for nonambulatory patients, (4) dysphagia screening before any oral intake, (5) carotid imaging, (6) assessment or receiving of rehabilitation and 7 performance measures at discharge: (1) antithrombotic medication, (2) anticoagulation for atrial fibrillation, (3) antihypertensive medication for patients with hypertension, (4) medications for lowering low-density lipoprotein ≥100 mg/dL, (5) hypoglycemia medication for diabetes mellitus, (6) smoking cessation, and (7) stroke education (Table Ⅱ in the online-only Data Supplement).…”

Section: Quality Measures For Stroke Care and Preventionmentioning

confidence: 99%

See 3 more Smart Citations

Substantial Progress Yet Significant Opportunity for Improvement in Stroke Care in China

Wang

et al. 2016

Stroke

135

View full text Add to dashboard Cite

S troke remains to be the leading cause of mortality in China and was responsible for ≈1.9 million deaths in 2013. 1 Despite advances in diagnosis and treatments for stroke, adherence to evidence-based stroke care has been suboptimal based on several national studies conducted before 2009. 2,3 Since then, improving the quality of stroke care has become Background and Purpose-Stroke is a leading cause of death in China. Yet the adherence to guideline-recommended ischemic stroke performance metrics in the past decade has been previously shown to be suboptimal. Since then, several nationwide stroke quality management initiatives have been conducted in China. We sought to determine whether adherence had improved since then. However, there were no significant improvements in the rates of intravenous thrombolytic therapy and anticoagulation for atrial fibrillation. After multivariate analysis, there remained a significant 1.17-fold (95% confidence interval, 1.14-1.21) increase in the odds of delivering evidence-based performance metrics in the more recent time periods versus older data. The performance metrics with the most significantly increased odds included stroke education, dysphagia screening, smoking cessation, and antithrombotics at discharge. Conclusions-Adherence to stroke performance metrics has increased over time, but significant opportunities remain for further improvement. Continuous stroke quality improvement program should be developed as a national priority in China. Methods-Data

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Strokementioning

confidence: 99%

Section: Quality Measures For Stroke Care and Preventionmentioning

confidence: 99%

See 2 more Smart Citations

Substantial Progress Yet Significant Opportunity for Improvement in Stroke Care in China

Wang

et al. 2016

Stroke

135

View full text Add to dashboard Cite

show abstract

“…35,37,39,50,51,55,56,58 Others indicated patient factors to consider (age, sex, timing/territory/ severity of symptoms, and comorbidities) without specifying how these should direct treatment decisions. 33,36,38,46,47,53,57,61,62 Others endorsed CEA for selected patients with moderate average-CEA-risk SCS without defining selected (Table 2). 34,42,48 …”

mentioning

confidence: 99%

Systematic Review of Guidelines for the Management of Asymptomatic and Symptomatic Carotid Stenosis

Abbott

Paraskevas

Kakkos

et al. 2015

Stroke

250

212

View full text Add to dashboard Cite

Background and Purpose-We systematically compared and appraised contemporary guidelines on management of asymptomatic and symptomatic carotid artery stenosis. Methods-We systematically searched for guideline recommendations on carotid endarterectomy (CEA) or carotid angioplasty/stenting (CAS) published in any language between January 1, 2008, and January 28, 2015. Only the latest guideline per writing group was selected. Each guideline was analyzed independently by 2 to 6 authors to determine clinical scenarios covered, recommendations given, and scientific evidence used. Results-Thirty-four eligible guidelines were identified from 23 different regions/countries in 6 languages. Of 28 guidelines with asymptomatic carotid artery stenosis procedural recommendations, 24 (86%) endorsed CEA (recommended it should or may be provided) for ≈50% to 99% average-surgical-risk asymptomatic carotid artery stenosis, 17 (61%) endorsed CAS, 8 (29%) opposed CAS, and 1 (4%) endorsed medical treatment alone. For asymptomatic carotid artery stenosis patients considered high-CEA-risk because of comorbidities, vascular anatomy, or undefined reasons, CAS was endorsed in 13 guidelines (46%). Thirty-one of 33 guidelines (94%) with symptomatic carotid artery stenosis procedural recommendations endorsed CEA for patients with ≈50% to 99% average-CEA-risk symptomatic carotid artery stenosis, 19 (58%) endorsed CAS and 9 (27%) opposed CAS. For high-CEA-risk symptomatic carotid artery stenosis because of comorbidities, vascular anatomy, or undefined reasons, CAS was endorsed in 27 guidelines (82%). Guideline procedural recommendations were based only on results of trials in which patients were randomized 12 to 34 years ago, rarely reflected medical treatment improvements and often understated potential CAS hazards. Qualifying terminology summarizing recommendations or evidence lacked standardization, impeding guideline interpretation, and comparison. This systematic review of contemporary international guidelines was performed to compare and appraise recommendations for the management of patients with ACS and SCS (including accessibility, organization, clarity, and consistency) and the evidence used in making these recommendations. Conclusions-This Methods Guideline SearchesGuidelines with recommendations on the use of CEA or CAS or both patients with ACS or SCS or both were sought systematically using popular search engines, bibliographies, and author professional networks. PubMed and ISI Web of Knowledge were searched independently and synchronously by 2 authors on September 9, 2013 (A.L.A., K.I.P.). PubMed was searched using carotid guideline and then stroke guideline in the title, yielding 91 references after duplicate removal. ISI Web of Knowledge was searched using carotid and guideline and then stroke and guideline in the title, yielding 422 references after removal of duplicates, abstracts, reference materials, letters, corrections, meetings, news, and case reports. Wider searches using the words carotid or stroke and guideline in any ...

show abstract

Association BetweenCYP2C19Loss-of-Function Allele Status and Efficacy of Clopidogrel for Risk Reduction Among Patients With Minor Stroke or Transient Ischemic Attack

Wang

Zhao

Lin

et al. 2016

JAMA

306

260

View full text Add to dashboard Cite

IMPORTANCE Data are limited regarding the association between CYP2C19 genetic variants and clinical outcomes of patients with minor stroke or transient ischemic attack treated with clopidogrel. OBJECTIVE To estimate the association between CYP2C19 genetic variants and clinical outcomes of clopidogrel-treated patients with minor stroke or transient ischemic attack. DESIGN, SETTING, AND PARTICIPANTS Three CYP2C19 major alleles (*2, *3, *17) were genotyped among 2933 Chinese patients from 73 sites who were enrolled in the Clopidogrel in High-Risk Patients with Acute Nondisabling Cerebrovascular Events (CHANCE) randomized trial conducted from January 2, 2010, to March 20, 2012. INTERVENTIONS Patients with acute minor ischemic stroke or transient ischemic attack in the trial were randomized to treatment with clopidogrel combined with aspirin or to aspirin alone. MAIN OUTCOMES AND MEASURESThe primary efficacy outcome was new stroke. The secondary efficacy outcome was a composite of new composite vascular events (ischemic stroke, hemorrhagic stroke, myocardial infarction, or vascular death). Bleeding was the safety outcome. RESULTS Among 2933 patients, 1948 (66.4%) were men, with a mean age of 62.4 years. Overall, 1207 patients (41.2%) were noncarriers and 1726 patients (58.8%) were carriers of loss-of-function alleles (*2, *3). After day 90 follow-up, clopidogrel-aspirin reduced the rate of new stroke in the noncarriers but not in the carriers of the loss-of-function alleles (P = .02 for interaction; events among noncarriers, 41 [6.7%] with clopidogrel-aspirin vs 74 [12.4%] with aspirin; hazard ratio [HR], 0.51 [95% CI, 0.35-0.75]; events among carriers, 80 [9.4%] with clopidogrel-aspirin vs 94 [10.8%] with aspirin; HR, 0.93 [95% CI, 0.69 to 1.26]). Similar results were observed for the secondary composite efficacy outcome (noncarriers: 41 [6.7%] with clopidogrel-aspirin vs 75 [12.5%] with aspirin; HR, 0.50 [95% CI, 0.34-0.74]; carriers: 80 [9.4%] with clopidogrel-aspirin vs 95 [10.9%] with aspirin; HR, 0.92 [95% CI, 0.68-1.24]; P = .02 for interaction). The effect of treatment assignment on bleeding did not vary significantly between the carriers and the noncarriers of the loss-of-function alleles (2.3% for carriers and 2.5% for noncarriers in the clopidogrel-aspirin group vs 1.4% for carriers and 1.7% for noncarriers in the aspirin only group; P = .78 for interaction). CONCLUSIONS AND RELEVANCE Among patients with minor ischemic stroke or transient ischemic attack, the use of clopidogrel plus aspirin compared with aspirin alone reduced the risk of a new stroke only in the subgroup of patients who were not carriers of the CYP2C19 loss-of-function alleles. These findings support a role of CYP2C19 genotype in the efficacy of this treatment.

show abstract

Chinese Guidelines for the Secondary Prevention of Ischemic Stroke and Transient Ischemic Attack 2010

Abstract: (above sort by family name); on behalf of the guidelines writing group of secondary prevention for ischemic stroke of cerebrovascular disease group of neurologic branch of Chinese medical association.

Cited by 95 publications

References 51 publications

Substantial Progress Yet Significant Opportunity for Improvement in Stroke Care in China

Substantial Progress Yet Significant Opportunity for Improvement in Stroke Care in China

Systematic Review of Guidelines for the Management of Asymptomatic and Symptomatic Carotid Stenosis

Association BetweenCYP2C19Loss-of-Function Allele Status and Efficacy of Clopidogrel for Risk Reduction Among Patients With Minor Stroke or Transient Ischemic Attack

Contact Info

Product

Resources

About