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Program enhances stroke care at nearly 3,000 U.S. hospitals

Nurse Ivo Edimo works with a stroke patient on an activity to improve balance and coordination during an intensive inpatient rehabilitation program at UT Southwestern’s Zale Lipshy Pavilion. The fifth-leading cause of death in the U.S., stroke is a major contributor to long-term disability and requires rapid, consistent treatment to prevent life-altering complications.
Nurse Ivo Edimo works with a stroke patient on an activity to improve balance and coordination during an intensive inpatient rehabilitation program at UT Southwestern’s Zale Lipshy Pavilion. The fifth-leading cause of death in the U.S., stroke is a major contributor to long-term disability and requires rapid, consistent treatment to prevent life-altering complications.
Nurse Ivo Edimo works with a stroke patient on an activity to improve balance and coordination during an intensive inpatient rehabilitation program at UT Southwestern’s Zale Lipshy Pavilion. The fifth-leading cause of death in the U.S., stroke is a major contributor to long-term disability and requires rapid, consistent treatment to prevent life-altering complications.

Study led by UT Southwestern shows AHA’s Get With The Guidelines-Stroke initiative improves outcomes for millions

Ying Xian, M.D., Ph.D.

Study lead author Ying Xian, M.D., Ph.D., is Associate Professor of Neurology and Head of Research for UTSW’s Cerebrovascular Diseases and Stroke Section.

 A study led by a researcher at UT Southwestern Medical Center shows a national initiative significantly improved stroke outcomes for millions of patients over its first 20 years, enhancing quality of care and consistency at more than 2,800 U.S. hospitals including UTSW.

The findings, published in Stroke, highlight the impact of the American Heart Association’s Get With The Guidelines-Stroke (GWTG-Stroke) program as a transformative force in establishing standardized, data-driven stroke treatment nationwide.

“With two decades of data, our study demonstrates that a well-designed national quality improvement initiative can lead to sustained and substantial enhancements in adherence to evidence-based practices in all performance metrics, regardless of the type of cerebrovascular event, across diverse populations and locales,” said lead author Ying Xian, M.D., Ph.D., Associate Professor of Neurology and Head of Research for UTSW’s Cerebrovascular Diseases and Stroke Section.

As the fifth-leading cause of death in the U.S. and a major contributor to long-term disability, stroke requires rapid, consistent treatment to prevent life-altering complications. Since its inception in 2003, the GWTG-Stroke program has grown to cover over 75% of stroke hospitalizations nationwide, capturing data from more than 9 million stroke cases. This extensive dataset enables ongoing evaluation and refinement of stroke care practices. Through its standardized protocols for rapid intervention and targeted treatments, the program has effectively addressed many inconsistencies in stroke management, offering hospitals a unified approach to improving patient care.

Stroke Program Data
(April 2003-December 2022)

Total stroke cases - 7,837,849

Hospitals - 2,865

Patient data - Median age 71 years; 51% female

Types of strokes

  • 69.2% ischemic
  • 15.3% transient ischemic attack (TIA)
  • 11.5% intracerebral hemorrhage (ICH)
  • 3.9% subarachnoid hemorrhage (SAH)

Improvements
(from 2003 to 2022)

  • Anticoagulation for atrial fibrillation (from 55.7% to 97.2%)
  • Smoking cessation counseling (from 44.7% to 97.8%)
  • Dysphagia screening (from 53.8% to 83.5%)
  • Thrombolytic treatment for patients arriving by 3.5 hours, treat by 4.5 hours (from 15.2% to 92.9%)
  • Door-to-needle time within 60 minutes (from 19.0% to 75.3%)

The study found that hospitals participating in the program delivered lifesaving interventions more swiftly. The proportion of ischemic stroke patients receiving thrombolytic therapy within 60 minutes of hospital arrival rose from 19% to 75.3%, significantly boosting patients’ recovery potential. Additionally, endovascular therapy response times showed notable reductions, reflecting the program’s focus on rapid intervention and enhancing patient recovery prospects.

Analysis also shows that hospitals achieved sustained improvements in critical care metrics. For example, among patients with acute ischemic stroke, rates of anticoagulation for atrial fibrillation increased from 55.7% in 2003 to 97.2% in 2022.

Other key measures also showed significant improvement: dysphagia screening rates rose from 53.8% to 83.5%, and smoking cessation counseling increased from 44.7% to 97.8%. Notably, improvements spanned all types of strokes covered by the program, including subarachnoid hemorrhage, intracerebral hemorrhage, and transient ischemic attack (TIA). 

“These improvements in stroke care quality mean that more patients can go straight home after their stroke, with fewer deaths, shorter hospital stays, and less need for hospitalization in skilled nursing facilities,” said Dr. Xian, who is also an Investigator in the Peter O’Donnell Jr. Brain Institute. “Significantly, the GWTG-Stroke program has established a global standard for stroke care, serving as a model for improving health care quality through data-driven, evidence-based interventions.”