Skip to main content
NCBI home page
Journal of the National Medical Association logoLink to Journal of the National Medical Association
. 2004 Apr;96(4 Suppl):5S–20S.

Stroke Best Practices: a team approach to evidence-based care.

Mark J Alberts 1, J Donald Easton 1
PMCID: PMC2719999  PMID: 15104312

Abstract

Reducing the high morbidity and mortality associated with stroke continues to be a major healthcare challenge in the United States. Recent advances in the management and prevention of atherothrombotic events are significant; however, the clinical application of evidence-based "best practices" is lagging in many hospitals across the country. The "Stroke Best Practices" program was designed to assist institutions that lack established stroke centers integrate recent evidence-based recommendations into individualized, in-hospital initiatives to optimize the management of acute stroke, prevent secondary vascular events, and enhance the quality of care for patients with established cerebrovascular disease. Programs that bridge the gap between evidence-based medicine and clinical practice can improve patient outcomes.

Full text

PDF
5S

Images in this article

11SFigure 3
on p.11S
12SFigure 4
on p.12S

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Adams Harold P., Jr, Adams Robert J., Brott Thomas, del Zoppo Gregory J., Furlan Anthony, Goldstein Larry B., Grubb Robert L., Higashida Randall, Kidwell Chelsea, Kwiatkowski Thomas G. Guidelines for the early management of patients with ischemic stroke: A scientific statement from the Stroke Council of the American Stroke Association. Stroke. 2003 Apr;34(4):1056–1083. doi: 10.1161/01.STR.0000064841.47697.22. [DOI] [PubMed] [Google Scholar]
  2. Albers G. W., Amarenco P., Easton J. D., Sacco R. L., Teal P. Antithrombotic and thrombolytic therapy for ischemic stroke. Chest. 2001 Jan;119(1 Suppl):300S–320S. doi: 10.1378/chest.119.1_suppl.300s. [DOI] [PubMed] [Google Scholar]
  3. Alberts M. J., Hademenos G., Latchaw R. E., Jagoda A., Marler J. R., Mayberg M. R., Starke R. D., Todd H. W., Viste K. M., Girgus M. Recommendations for the establishment of primary stroke centers. Brain Attack Coalition. JAMA. 2000 Jun 21;283(23):3102–3109. doi: 10.1001/jama.283.23.3102. [DOI] [PubMed] [Google Scholar]
  4. Antithrombotic Trialists' Collaboration Collaborative meta-analysis of randomised trials of antiplatelet therapy for prevention of death, myocardial infarction, and stroke in high risk patients. BMJ. 2002 Jan 12;324(7329):71–86. doi: 10.1136/bmj.324.7329.71. [DOI] [PMC free article] [PubMed] [Google Scholar]
  5. Biller J., Feinberg W. M., Castaldo J. E., Whittemore A. D., Harbaugh R. E., Dempsey R. J., Caplan L. R., Kresowik T. F., Matchar D. B., Toole J. f. Guidelines for carotid endarterectomy: a statement for healthcare professionals from a special writing group of the Stroke Council, American Heart Association. Stroke. 1998 Feb;29(2):554–562. doi: 10.1161/01.str.29.2.554. [DOI] [PubMed] [Google Scholar]
  6. Braunwald Eugene, Antman Elliott M., Beasley John W., Califf Robert M., Cheitlin Melvin D., Hochman Judith S., Jones Robert H., Kereiakes Dean, Kupersmith Joel, Levin Thomas N. ACC/AHA guideline update for the management of patients with unstable angina and non-ST-segment elevation myocardial infarction--2002: summary article: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on the Management of Patients With Unstable Angina). Circulation. 2002 Oct 1;106(14):1893–1900. doi: 10.1161/01.cir.0000037106.76139.53. [DOI] [PubMed] [Google Scholar]
  7. Bravata Dawn M., Ho Shih-Yieh, Brass Lawrence M., Concato John, Scinto Jeanne, Meehan Thomas P. Long-term mortality in cerebrovascular disease. Stroke. 2003 Feb 20;34(3):699–704. doi: 10.1161/01.STR.0000057578.26828.78. [DOI] [PubMed] [Google Scholar]
  8. Bruno A., Biller J., Adams H. P., Jr, Clarke W. R., Woolson R. F., Williams L. S., Hansen M. D. Acute blood glucose level and outcome from ischemic stroke. Trial of ORG 10172 in Acute Stroke Treatment (TOAST) Investigators. Neurology. 1999 Jan 15;52(2):280–284. doi: 10.1212/wnl.52.2.280. [DOI] [PubMed] [Google Scholar]
  9. Bruno A., Levine S. R., Frankel M. R., Brott T. G., Lin Y., Tilley B. C., Lyden P. D., Broderick J. P., Kwiatkowski T. G., Fineberg S. E. Admission glucose level and clinical outcomes in the NINDS rt-PA Stroke Trial. Neurology. 2002 Sep 10;59(5):669–674. doi: 10.1212/wnl.59.5.669. [DOI] [PubMed] [Google Scholar]
  10. Brønnum-Hansen H., Davidsen M., Thorvaldsen P., Danish MONICA Study Group Long-term survival and causes of death after stroke. Stroke. 2001 Sep;32(9):2131–2136. doi: 10.1161/hs0901.094253. [DOI] [PubMed] [Google Scholar]
  11. Chobanian Aram V., Bakris George L., Black Henry R., Cushman William C., Green Lee A., Izzo Joseph L., Jr, Jones Daniel W., Materson Barry J., Oparil Suzanne, Wright Jackson T., Jr The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: the JNC 7 report. JAMA. 2003 May 14;289(19):2560–2572. doi: 10.1001/jama.289.19.2560. [DOI] [PubMed] [Google Scholar]
  12. De Schryver E. L. Design of ESPRIT: an international randomized trial for secondary prevention after non-disabling cerebral ischaemia of arterial origin. European/Australian Stroke Prevention in Reversible Ischaemia Trial (ESPRIT) group. Cerebrovasc Dis. 2000 Mar-Apr;10(2):147–150. doi: 10.1159/000016044. [DOI] [PubMed] [Google Scholar]
  13. Diener H. C., Cunha L., Forbes C., Sivenius J., Smets P., Lowenthal A. European Stroke Prevention Study. 2. Dipyridamole and acetylsalicylic acid in the secondary prevention of stroke. J Neurol Sci. 1996 Nov;143(1-2):1–13. doi: 10.1016/s0022-510x(96)00308-5. [DOI] [PubMed] [Google Scholar]
  14. Fonarow G. C., Gawlinski A., Moughrabi S., Tillisch J. H. Improved treatment of coronary heart disease by implementation of a Cardiac Hospitalization Atherosclerosis Management Program (CHAMP). Am J Cardiol. 2001 Apr 1;87(7):819–822. doi: 10.1016/s0002-9149(00)01519-8. [DOI] [PubMed] [Google Scholar]
  15. Goldstein L. B., Adams R., Becker K., Furberg C. D., Gorelick P. B., Hademenos G., Hill M., Howard G., Howard V. J., Jacobs B. Primary prevention of ischemic stroke: A statement for healthcare professionals from the Stroke Council of the American Heart Association. Circulation. 2001 Jan 2;103(1):163–182. doi: 10.1161/01.cir.103.1.163. [DOI] [PubMed] [Google Scholar]
  16. Gorelick P. B. Stroke prevention. An opportunity for efficient utilization of health care resources during the coming decade. Stroke. 1994 Jan;25(1):220–224. doi: 10.1161/01.str.25.1.220. [DOI] [PubMed] [Google Scholar]
  17. Hacke Werner. From CURE to MATCH: ADP receptor antagonists as the treatment of choice for high-risk atherothrombotic patients. Cerebrovasc Dis. 2002;13 (Suppl 1):22–26. doi: 10.1159/000047786. [DOI] [PubMed] [Google Scholar]
  18. Hardie Kate, Hankey Graeme J., Jamrozik Konrad, Broadhurst Robyn J., Anderson Craig. Ten-year survival after first-ever stroke in the perth community stroke study. Stroke. 2003 Jul 3;34(8):1842–1846. doi: 10.1161/01.STR.0000082382.42061.EE. [DOI] [PubMed] [Google Scholar]
  19. Hardie Kate, Hankey Graeme J., Jamrozik Konrad, Broadhurst Robyn J., Anderson Craig. Ten-year survival after first-ever stroke in the perth community stroke study. Stroke. 2003 Jul 3;34(8):1842–1846. doi: 10.1161/01.STR.0000082382.42061.EE. [DOI] [PubMed] [Google Scholar]
  20. Hart R. G., Benavente O., McBride R., Pearce L. A. Antithrombotic therapy to prevent stroke in patients with atrial fibrillation: a meta-analysis. Ann Intern Med. 1999 Oct 5;131(7):492–501. doi: 10.7326/0003-4819-131-7-199910050-00003. [DOI] [PubMed] [Google Scholar]
  21. Howard G., Anderson R., Sorlie P., Andrews V., Backlund E., Burke G. L. Ethnic differences in stroke mortality between non-Hispanic whites, Hispanic whites, and blacks. The National Longitudinal Mortality Study. Stroke. 1994 Nov;25(11):2120–2125. doi: 10.1161/01.str.25.11.2120. [DOI] [PubMed] [Google Scholar]
  22. Johnston S. C., Gress D. R., Browner W. S., Sidney S. Short-term prognosis after emergency department diagnosis of TIA. JAMA. 2000 Dec 13;284(22):2901–2906. doi: 10.1001/jama.284.22.2901. [DOI] [PubMed] [Google Scholar]
  23. Marler J. R., Tilley B. C., Lu M., Brott T. G., Lyden P. C., Grotta J. C., Broderick J. P., Levine S. R., Frankel M. P., Horowitz S. H. Early stroke treatment associated with better outcome: the NINDS rt-PA stroke study. Neurology. 2000 Dec 12;55(11):1649–1655. doi: 10.1212/wnl.55.11.1649. [DOI] [PubMed] [Google Scholar]
  24. Mehta Rajendra H., Montoye Cecelia K., Gallogly Meg, Baker Patricia, Blount Angela, Faul Jessica, Roychoudhury Canopy, Borzak Steven, Fox Susan, Franklin Mary. Improving quality of care for acute myocardial infarction: The Guidelines Applied in Practice (GAP) Initiative. JAMA. 2002 Mar 13;287(10):1269–1276. doi: 10.1001/jama.287.10.1269. [DOI] [PubMed] [Google Scholar]
  25. Mohr J. P., Thompson J. L., Lazar R. M., Levin B., Sacco R. L., Furie K. L., Kistler J. P., Albers G. W., Pettigrew L. C., Adams H. P., Jr A comparison of warfarin and aspirin for the prevention of recurrent ischemic stroke. N Engl J Med. 2001 Nov 15;345(20):1444–1451. doi: 10.1056/NEJMoa011258. [DOI] [PubMed] [Google Scholar]
  26. National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III) Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III) final report. Circulation. 2002 Dec 17;106(25):3143–3421. [PubMed] [Google Scholar]
  27. Ness J., Aronow W. S. Prevalence of coexistence of coronary artery disease, ischemic stroke, and peripheral arterial disease in older persons, mean age 80 years, in an academic hospital-based geriatrics practice. J Am Geriatr Soc. 1999 Oct;47(10):1255–1256. doi: 10.1111/j.1532-5415.1999.tb05208.x. [DOI] [PubMed] [Google Scholar]
  28. PROGRESS Collaborative Group Randomised trial of a perindopril-based blood-pressure-lowering regimen among 6,105 individuals with previous stroke or transient ischaemic attack. Lancet. 2001 Sep 29;358(9287):1033–1041. doi: 10.1016/S0140-6736(01)06178-5. [DOI] [PubMed] [Google Scholar]
  29. Randomised trial of cholesterol lowering in 4444 patients with coronary heart disease: the Scandinavian Simvastatin Survival Study (4S) Lancet. 1994 Nov 19;344(8934):1383–1389. [PubMed] [Google Scholar]
  30. Reed S. D., Cramer S. C., Blough D. K., Meyer K., Jarvik J. G. Treatment with tissue plasminogen activator and inpatient mortality rates for patients with ischemic stroke treated in community hospitals. Stroke. 2001 Aug;32(8):1832–1840. doi: 10.1161/01.str.32.8.1832. [DOI] [PubMed] [Google Scholar]
  31. Rodgers A., MacMahon S., Gamble G., Slattery J., Sandercock P., Warlow C. Blood pressure and risk of stroke in patients with cerebrovascular disease. The United Kingdom Transient Ischaemic Attack Collaborative Group. BMJ. 1996 Jul 20;313(7050):147–147. doi: 10.1136/bmj.313.7050.147. [DOI] [PMC free article] [PubMed] [Google Scholar]
  32. Rothwell P. M., Eliasziw M., Gutnikov S. A., Fox A. J., Taylor D. W., Mayberg M. R., Warlow C. P., Barnett H. J. M., Carotid Endarterectomy Trialists' Collaboration Analysis of pooled data from the randomised controlled trials of endarterectomy for symptomatic carotid stenosis. Lancet. 2003 Jan 11;361(9352):107–116. doi: 10.1016/s0140-6736(03)12228-3. [DOI] [PubMed] [Google Scholar]
  33. Sacco R. L., Benjamin E. J., Broderick J. P., Dyken M., Easton J. D., Feinberg W. M., Goldstein L. B., Gorelick P. B., Howard G., Kittner S. J. American Heart Association Prevention Conference. IV. Prevention and Rehabilitation of Stroke. Risk factors. Stroke. 1997 Jul;28(7):1507–1517. doi: 10.1161/01.str.28.7.1507. [DOI] [PubMed] [Google Scholar]
  34. Sacks F. M., Pfeffer M. A., Moye L. A., Rouleau J. L., Rutherford J. D., Cole T. G., Brown L., Warnica J. W., Arnold J. M., Wun C. C. The effect of pravastatin on coronary events after myocardial infarction in patients with average cholesterol levels. Cholesterol and Recurrent Events Trial investigators. N Engl J Med. 1996 Oct 3;335(14):1001–1009. doi: 10.1056/NEJM199610033351401. [DOI] [PubMed] [Google Scholar]
  35. Stary H. C., Chandler A. B., Dinsmore R. E., Fuster V., Glagov S., Insull W., Jr, Rosenfeld M. E., Schwartz C. J., Wagner W. D., Wissler R. W. A definition of advanced types of atherosclerotic lesions and a histological classification of atherosclerosis. A report from the Committee on Vascular Lesions of the Council on Arteriosclerosis, American Heart Association. Circulation. 1995 Sep 1;92(5):1355–1374. doi: 10.1161/01.cir.92.5.1355. [DOI] [PubMed] [Google Scholar]
  36. Stary H. C., Chandler A. B., Dinsmore R. E., Fuster V., Glagov S., Insull W., Jr, Rosenfeld M. E., Schwartz C. J., Wagner W. D., Wissler R. W. A definition of advanced types of atherosclerotic lesions and a histological classification of atherosclerosis. A report from the Committee on Vascular Lesions of the Council on Arteriosclerosis, American Heart Association. Circulation. 1995 Sep 1;92(5):1355–1374. doi: 10.1161/01.cir.92.5.1355. [DOI] [PubMed] [Google Scholar]
  37. Steinhubl Steven R., Berger Peter B., Mann J. Tift, 3rd, Fry Edward T. A., DeLago Augustin, Wilmer Charles, Topol Eric J., CREDO Investigators. Clopidogrel for the Reduction of Events During Observation Early and sustained dual oral antiplatelet therapy following percutaneous coronary intervention: a randomized controlled trial. JAMA. 2002 Nov 20;288(19):2411–2420. doi: 10.1001/jama.288.19.2411. [DOI] [PubMed] [Google Scholar]
  38. Straus Sharon E., Majumdar Sumit R., McAlister Finlay A. New evidence for stroke prevention: scientific review. JAMA. 2002 Sep 18;288(11):1388–1395. doi: 10.1001/jama.288.11.1388. [DOI] [PubMed] [Google Scholar]
  39. Straus Sharon E., Majumdar Sumit R., McAlister Finlay A. New evidence for stroke prevention: scientific review. JAMA. 2002 Sep 18;288(11):1388–1395. doi: 10.1001/jama.288.11.1388. [DOI] [PubMed] [Google Scholar]
  40. Stroke Unit Trialists' Collaboration Organised inpatient (stroke unit) care for stroke. Cochrane Database Syst Rev. 2002;(1):CD000197–CD000197. doi: 10.1002/14651858.CD000197. [DOI] [PubMed] [Google Scholar]
  41. Tissue plasminogen activator for acute ischemic stroke. The National Institute of Neurological Disorders and Stroke rt-PA Stroke Study Group. N Engl J Med. 1995 Dec 14;333(24):1581–1587. doi: 10.1056/NEJM199512143332401. [DOI] [PubMed] [Google Scholar]
  42. Warach S., Chien D., Li W., Ronthal M., Edelman R. R. Fast magnetic resonance diffusion-weighted imaging of acute human stroke. Neurology. 1992 Sep;42(9):1717–1723. doi: 10.1212/wnl.42.9.1717. [DOI] [PubMed] [Google Scholar]
  43. Warach S., Gaa J., Siewert B., Wielopolski P., Edelman R. R. Acute human stroke studied by whole brain echo planar diffusion-weighted magnetic resonance imaging. Ann Neurol. 1995 Feb;37(2):231–241. doi: 10.1002/ana.410370214. [DOI] [PubMed] [Google Scholar]
  44. Wilterdink J. L., Easton J. D. Vascular event rates in patients with atherosclerotic cerebrovascular disease. Arch Neurol. 1992 Aug;49(8):857–863. doi: 10.1001/archneur.1992.00530320089016. [DOI] [PubMed] [Google Scholar]
  45. Wilterdink J. L., Easton J. D. Vascular event rates in patients with atherosclerotic cerebrovascular disease. Arch Neurol. 1992 Aug;49(8):857–863. doi: 10.1001/archneur.1992.00530320089016. [DOI] [PubMed] [Google Scholar]
  46. Yusuf S., Sleight P., Pogue J., Bosch J., Davies R., Dagenais G. Effects of an angiotensin-converting-enzyme inhibitor, ramipril, on cardiovascular events in high-risk patients. The Heart Outcomes Prevention Evaluation Study Investigators. N Engl J Med. 2000 Jan 20;342(3):145–153. doi: 10.1056/NEJM200001203420301. [DOI] [PubMed] [Google Scholar]
  47. Yusuf S., Zhao F., Mehta S. R., Chrolavicius S., Tognoni G., Fox K. K., Clopidogrel in Unstable Angina to Prevent Recurrent Events Trial Investigators Effects of clopidogrel in addition to aspirin in patients with acute coronary syndromes without ST-segment elevation. N Engl J Med. 2001 Aug 16;345(7):494–502. doi: 10.1056/NEJMoa010746. [DOI] [PubMed] [Google Scholar]

Articles from Journal of the National Medical Association are provided here courtesy of National Medical Association

RESOURCES