Integrated Care Using the ABC_stroke Pathway Improves Cardiovascular Outcomes and Survival in Patients with First-Ever Ischaemic Stroke.

IF 3.1 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Global Heart Pub Date : 2025-05-27 eCollection Date: 2025-01-01 DOI:10.5334/gh.1430

Christopher T W Tsang, Sylvia E Choi, Tommaso Bucci, Jia-Yi Huang, Qing-Wen Ren, Mei-Zhen Wu, Wen-Li Gu, Ran Guo, Jing-Nan Zhang, Anthony O T Ma, Steven H M Lam, Yap-Hang Chan, Kui-Kai Lau, Hung-Fat Tse, Azmil H Abdul-Rahim, Gregory Y H Lip, Kai-Hang Yiu

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Abstract

Background: A recent position paper of the European Society of Cardiology Council on Stroke proposed an integrated ABC_stroke pathway to optimise post-stroke management. We evaluated the impact of ABC_stroke pathway adherence on post-stroke cardiovascular outcomes.

Methods: Patients with first-ever ischaemic stroke in Hong Kong between 2006 and 2022 were included in this retrospective cohort study. Multivariable Cox regression analysis was performed to evaluate the association between physicians' adherence to the ABC_stroke pathway and the primary outcome, which was a composite of recurrent ischaemic stroke, transient ischaemic attack, haemorrhagic stroke, myocardial infarction, heart failure and all-cause mortality.

Results: Of the 9,669 included patients with ischaemic stroke (mean age 69.6 ± 13.4 years; 57.5% male), 58.1% were optimally managed according to all three ABC_stroke pillars. After 1 year of follow-up, adherence to the ABC_stroke pathway was associated with a lower risk of the primary composite endpoint (hazard ratio (HR): 0.80; 95% confidence interval (CI): 0.72-0.88), as well as a lower risk of haemorrhagic stroke (subdistribution hazard ratio (SHR): 0.50; 95% CI: 0.38-0.67), heart failure (SHR: 0.771; 95% CI: 0.596-0.998), cardiovascular death (SHR: 0.64; 95% CI: 0.45-0.90), and all-cause mortality (HR: 0.72; 95% CI: 0.62-0.85). Risk reductions in the primary endpoint increased progressively with a higher number of ABC_stroke criteria obtained. No significant interaction was observed in the association according to age, sex, or stroke severity.

Conclusions: In this cohort of Asian patients with first-ever ischaemic stroke, optimal management according to the ABC_stroke pathway was associated with a reduction in the risk of adverse outcomes.

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采用abc卒中途径的综合护理可改善首次缺血性卒中患者的心血管预后和生存率。

背景：最近欧洲心脏病学会卒中理事会的一份立场文件提出了一种综合的abc卒中途径来优化卒中后管理。我们评估了abc卒中途径依从性对卒中后心血管结局的影响。方法：2006年至2022年香港首次缺血性脑卒中患者纳入回顾性队列研究。采用多变量Cox回归分析来评估医生坚持abc卒中途径与主要结局（复发性缺血性卒中、短暂性缺血性卒中、出血性卒中、心肌梗死、心力衰竭和全因死亡率）之间的关系。结果：9669例缺血性脑卒中患者(平均年龄69.6±13.4岁；57.5%男性)，58.1%的患者根据所有三个abc卒中支柱进行优化管理。随访1年后，坚持abc卒中途径与主要复合终点的风险较低相关(风险比（HR）： 0.80；95%可信区间（CI）： 0.72-0.88)，以及出血性卒中的风险较低(亚分布风险比（SHR）： 0.50；95% CI: 0.38-0.67)，心力衰竭(SHR: 0.771；95% CI: 0.596-0.998)，心血管死亡(SHR: 0.64；95% CI: 0.45-0.90)和全因死亡率(HR: 0.72；95% ci: 0.62-0.85)。随着获得更多的abc卒中标准，主要终点的风险降低逐渐增加。根据年龄、性别或中风严重程度，没有观察到显著的相互作用。结论：在亚洲首次缺血性卒中患者队列中，根据abc卒中途径进行最佳管理与不良后果风险降低相关。

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来源期刊

Global Heart Medicine-Cardiology and Cardiovascular Medicine

CiteScore

5.70

自引率

5.40%

发文量

审稿时长

5 weeks

期刊介绍： Global Heart offers a forum for dialogue and education on research, developments, trends, solutions and public health programs related to the prevention and control of cardiovascular diseases (CVDs) worldwide, with a special focus on low- and middle-income countries (LMICs). Manuscripts should address not only the extent or epidemiology of the problem, but also describe interventions to effectively control and prevent CVDs and the underlying factors. The emphasis should be on approaches applicable in settings with limited resources. Economic evaluations of successful interventions are particularly welcome. We will also consider negative findings if important. While reports of hospital or clinic-based treatments are not excluded, particularly if they have broad implications for cost-effective disease control or prevention, we give priority to papers addressing community-based activities. We encourage submissions on cardiovascular surveillance and health policies, professional education, ethical issues and technological innovations related to prevention. Global Heart is particularly interested in publishing data from updated national or regional demographic health surveys, World Health Organization or Global Burden of Disease data, large clinical disease databases or registries. Systematic reviews or meta-analyses on globally relevant topics are welcome. We will also consider clinical research that has special relevance to LMICs, e.g. using validated instruments to assess health-related quality-of-life in patients from LMICs, innovative diagnostic-therapeutic applications, real-world effectiveness clinical trials, research methods (innovative methodologic papers, with emphasis on low-cost research methods or novel application of methods in low resource settings), and papers pertaining to cardiovascular health promotion and policy (quantitative evaluation of health programs.