ArticlePharmacy practice
Impact of adherence to key performance indicators on mortality among patients managed for ischemic stroke.
Article in Pharmacy practice. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 6 papers.
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Who cites it
6 citing papers in PubMed.
- Clinical guideline-guided prognostic models of functional disability after acute ischemic stroke: a retrospective cohort study.BMC neurology · 2026Article
- Combining Machine Learning With Real-World Data to Identify Gaps in Clinical Practice Guidelines: Feasibility Study Using the Prospective German Stroke Registry and the National Acute Ischemic Stroke Guidelines.JMIR medical informatics · 2025Observational
- Direct medical cost of first-ever acute ischemic stroke in malaysia: a retrospective cohort study.Scientific reports · 2025Article
- Prognostic Models of Mortality Following First-Ever Acute Ischemic Stroke: A Population-Based Retrospective Cohort Study.Health science reports · 2025Article
- Article
- Variation in stroke care at the hospital level: A cross-sectional multicenter study.Frontiers in neurology · 2022Article
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9 authors.
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Abstract
backgroundStroke is a leading cause of death worldwide. The cases of acute ischemic stroke are on the increase in the Asia Pacific, particularly in Malaysia. Various health organizations have recommended guidelines for managing ischemic stroke, but adherence to key performance indicators (KPI) from the guidelines and impact on patient outcomes, particularly mortality, are rarely explored.
objectiveThis study aims to evaluate the impact of adherence to key performance indicators on mortality among patients managed for ischemic stroke.
methodsWe included all first-ever ischemic stroke patients enrolled in the multiethnic Malaysian National Neurology Registry (NNeuR) - a prospective cohort study and followed-up for six months. Patients' baseline clinical characteristics, risk factors, neurological findings, treatments, KPI and mortality outcome were evaluated. The KPI nonadherence (NAR) and relationship with mortality were evaluated. NAR>25% threshold was considered suboptimal.
resultsA total of 579 first-ever ischemic stroke patients were included in the final analysis. The overall mortality was recorded as 23 (4.0%) in six months, with a median (interquartile) age of 65 (20) years. Majority of the patients (dead or alive) had partial anterior circulation infarct, PACI (43.5%; 34.0%) and total anterior circulation infarct, TACI (26.1%; 8.8%). In addition, DVT prophylaxis (82.8%), anticoagulant for atrial fibrillation (AF) patients (48.8%) and rehabilitation (26.2%) were considered suboptimal. NAR < 2 was significantly associated with a decrease in mortality (odds ratio 0.16; 0.02-0.12) compared to NAR>2. Survival analysis showed that death is more likely in patients with NAR>2 (p=0.05).
conclusionsKPI nonadherence was associated with mortality among ischemic stroke patients. The adherence to the KPI was sub-optimal, particularly in DVT prophylaxis, anticoagulant for AF patients and rehabilitation. These findings reflect the importance of continuous quality measurement and implementation of evidence recommendations in healthcare delivery to achieve optimal outcome among stroke patients.
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