Abstract Details

Title Adherence to Blood Pressure Guidelines Predicts Hospital Readmission After Acute Stroke: The Florida Stroke Registry

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) S6 - Cerebrovascular Disease: Diagnosis, Prediction, and Population Health (4:18 PM-4:30 PM)

Poster/Presentation
Number 005

Background Blood Pressure (BP) management is central to secondary stroke prevention. We studied adherence to antihypertensive guidelines at the time of hospital discharge for stroke and examined the associations with 90-day hospital readmission rates in the Florida Stroke Registry (FSR).

Objective We hypothesize adherence to antihypertensive prescribing guidelines will predict 90-day stroke and hospital readmission rates. We explore race-ethnic associations.

Design/Methods

FSR stroke patients were matched and crossed linked with the statewide AHCA dataset from 2017-2019. Patients were included if had known hypertension, on antihypertensive medications or discharged BP >140/90. Adherence with the Joint National Committee (JNC) guidelines at discharge was defined as first line use of: 1) ACE inhibitors or angiotensin receptor blockers among diabetics. 2) diuretics or calcium channel blockers in African Americans (AA);

3) beta blockers (BB) for compelling cardiac indication (CCI) But avoidance of first- or second-line BB in patients without CCI. Multivariate analysis controlled for age, sex, race/ethnicity, DM, Afib, previous MI/CAD, presenting NIHSS, insurance status, stroke type/classification, and discharge location.

Results

Amongst 46705 study population (mean age=72, SD=14, 49% women, 63% White, 22% AA, 15% Hispanic), 52% were adherent. Older age (>65y vs. <45y), White and Hispanic race vs. AA were associated with higher adherence. In contrast, adherence was low amongst patients with diabetes, Afib, and MI/CAD (42% each). Post hospital 90-day readmission rate was 24.0%; 5.6% for recurrent stroke. In multivariate analysis, adherence with JNC guidelines resulted in a lower all-cause readmission risk (OR=0.91 [0.87-0.96]), but not stroke readmission (OR=0.97, 95% CI 0.89-1.05). Association between guideline adherence and 90-day all-cause readmission was similar for White, AA, and Hispanic patients.

Conclusions In this large stroke registry, almost half of stroke patients were not on appropriated BP therapies at discharge. Adherence with JNC BP guidelines significantly reduced the odds of 90-day hospital readmission across all race/ethnic groups in this study

Authors/Disclosures
Oriana Tascione, MD (University of Miami) PRESENTER	Dr. Tascione has nothing to disclose.
Hannah Gardener, ScD (University of Miami)	Ms. Gardener has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Intersocietal Accreditation Commission. Ms. Gardener has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Ellipse Analytics. Ms. Gardener has received personal compensation in the range of $10,000-$49,999 for serving as an Expert Witness for Baum Hedlund. Ms. Gardener has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant with A Green Slate Consulting.
Carolina Gutierrez	No disclosure on file
David Z. Rose, MD (USF)	Dr. Rose has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for Boston Scientific. Dr. Rose has received personal compensation in the range of $50,000-$99,999 for serving on a Speakers Bureau for Chiesi USA. Dr. Rose has received personal compensation in the range of $5,000-$9,999 for serving on a Speakers Bureau for Medtronic. Dr. Rose has received personal compensation in the range of $50,000-$99,999 for serving on a Speakers Bureau for Boehringer Ingelheim . Dr. Rose has received personal compensation in the range of $5,000-$9,999 for serving on a Speakers Bureau for CSL-Behring .
Tatjana Rundek, MD, PhD	The institution of Dr. Rundek has received research support from NIH.
	No disclosure on file
Jose G. Romano, MD, FAAN (University of Miami, Miller School of Medicine)	Dr. Romano has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Genentech. Dr. Romano has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Vycor. Dr. Romano has stock in Vycor Medical/NovaVision. The institution of Dr. Romano has received research support from NIH/NINDS. The institution of Dr. Romano has received research support from NIH/NIMHHD.
Ralph L. Sacco, MD, MS, FAHA	Dr. Sacco has received personal compensation in the range of $100,000-$499,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for American Heart Association. The institution of Dr. Sacco has received research support from NIH, NINDS, NCATS, NIMHD. The institution of Dr. Sacco has received research support from FL Department of Health. Dr. Sacco has received research support from University of Washington, Seattle. Dr. Sacco has received publishing royalties from a publication relating to health care.
Sebastian Koch, MD (University of Miami)	Dr. Koch has received personal compensation in the range of $10,000-$49,999 for serving as an Expert Witness for Multiple Legal Matters. Dr. Koch has received stock or an ownership interest from Cerepeutics. Dr. Koch has received intellectual property interests from a discovery or technology relating to health care. Dr. Koch has received intellectual property interests from a discovery or technology relating to health care.
Negar Asdaghi, MD (University of Miami)	Dr. Asdaghi has received personal compensation in the range of $500-$4,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for American Heart Association.
Gillian L. Gordon-Perue, MD, FAAN (University of Miami)	Dr. Gordon-Perue has nothing to disclose.