Hospitals Using Get With the Guidelines-Stroke Program Offer Better Quality Care in Ischemic Stroke

doctor comforting older patient in hospital
doctor comforting older patient in hospital
The Get With the Guidelines-Stroke program includes measures such as neurologist assessment, rehabilitation evaluation, and education on stroke risk factors.

Hospitals participating in the Get With the Guidelines-Stroke (GWTG-Stroke) program, an American Heart Association/American Stroke Association quality improvement program, provide higher quality of care for patients with ischemic stroke compared with nonparticipating hospitals, according to a study published in JAMA Neurology. These measures include neurologist assessment, rehabilitation evaluation, and education on stroke risk factors.

A subpopulation of patients with ischemic stroke (age ≥45 years) who participated in the longitudinal Reasons for Geographic and Racial Differences in Stroke study were enrolled (n=546). Approximately 36% (n=207) of patients with stroke were treated in a GWTG-Stroke-participating hospital, whereas 339 patients were treated in a nonparticipating hospital.

Investigators contrasted the quality of care provided by participating and nonparticipating hospitals for people with stroke. The primary outcome measures included a variety of quality care measures recommended in the GWTG-Stroke program, such as antithrombotic use in the first 48 hours of hospital admission, use of tissue plasminogen activator, and assessment of swallowing. Additional measures included evaluation of lipid profile, provision of antithrombotic therapy and/or statin medications at discharge, neurologist assessment, weight loss and exercise therapy, rehabilitation assessment, and education on stroke etiology.

Patients who received care in hospitals that participated in the GWTG-Stroke program were significantly more likely to receive 5 of 10 recommended interventions, including a tissue plasminogen activator (risk ratio [RR] 3.74; 95% CI, 1.65-8.50; P <.001), education on stroke risk factors (RR 1.54; 95% CI, 1.16-2.05; P =.005), swallowing evaluation (RR 1.25; 95% CI, 1.04-1.50; P =.003), lipid assessment (RR 1.18; 95% CI, 1.05-1.32; P =.002), and neurologist evaluation (RR 1.12; 95% CI, 1.05-1.20; P <.001).

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A potential limitation of the analysis was the reliance on medical records only to identify whether a GWTG-Stroke intervention was used.

Findings from this study indicate that “additional efforts to enhance hospital participation in GWTG-Stroke may have meaningful benefits in stroke care and outcomes.”


Howard G, Schwamm LH, Donnelly JP, et al. Participation in Get With the Guidelines–Stroke and its association with quality of care for stroke [published online August 6, 2018]. JAMA Neurol. doi:10.1001/jamaneurol.2018.2101