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Acute stroke clinical care standard indicators: 5b-Separation on statin, antihypertensive and antithrombotic medications for ischaemic stroke

Identifying and definitional attributes

Metadata item type:Help on this termIndicator
Indicator type:Help on this termIndicator
Short name:Help on this termIndicator 5b-Separation on statin, antihypertensive and antithrombotic medications for ischaemic stroke
METeOR identifier:Help on this term627809
Registration status:Help on this termHealth, Candidate 14/03/2017
Description:Help on this term

Proportion of patients with a final diagnosis of ischaemic stroke prescribed and administered statin, antihypertensive and antithrombotic medications, where not contraindicated, on separation from hospital.

Rationale:Help on this term

Ischaemic stroke patients should be provided statin, antihypertensive and antithrombotic medications on separation from hospital to ensure optimal outcomes.

Lowering lipid levels (using a statin) is an effective primary and secondary prevention treatment for vascular events, including stroke (The Stroke Prevention by Aggressive Reduction in Cholesterol Levels (SPARCL) Investigators 2006).

The use of antiplatelet drugs has been shown to provide a 22% reduction in vascular events (myocardial infarction, stroke or vascular death) in patients with a previous stroke or transient ischaemic attack (TIA) (Antithrombotic Trialists’ Collaboration 2002).

Most antihypertensive drugs have been shown to reduce blood pressure, the recurrence of stroke and cardiovascular events (Lakhan & Sapko 2009).

Indicator set:Help on this termClinical care standard indicators: acute stroke Health, Candidate 14/03/2017
Outcome area:Help on this termMinimising risk of another stroke Health, Candidate 14/03/2017

Collection and usage attributes

Computation description:Help on this term

Both the numerator and the denominator include patients with a final diagnosis of ischaemic stroke.

The numerator requires evidence of prescription and administration of antihypertensives, statins and antithrombotics prior to separation. Antithrombotic medications include: oral anticoagulants, such as warfarin, apixaban, rivaroxaban or dabigatran; and antiplatelet agents, such as aspirin, clopidogrel and dipyridamole.

Both the numerator and the denominator exclude patients for whom antihypertensives, statins or antithrombotics are contraindicated (where the contraindication is clearly documented). Contraindications may include:

  • symptomatic hypotension (for antihypertensives)
  • patient refusal
  • where there are limitations of therapy (i.e. advance care directive is enacted and/or the patient is on a palliative care pathway).

Presented as a percentage.

Computation:Help on this term

(Numerator ÷ denominator) x 100

Numerator:Help on this term

Number of patients with a final diagnosis of ischaemic stroke prescribed and administered statin, antihypertensive and antithrombotic medications on separation from hospital.

Denominator:Help on this term

Number of patients with a final diagnosis of ischaemic stroke separated from hospital.

Representational attributes

Representation class:Help on this termPercentage
Data type:Help on this termReal
Unit of measure:Help on this termEpisode
Format:Help on this term

N[NN]

Source and reference attributes

Submitting organisation:Help on this term

Australian Commission on Safety and Quality in Health Care

Reference documents:Help on this term

Antithrombotic Trialists’ Collaboration 2002. Collaborative meta‑analysis of randomised trials of antiplatelet therapy for prevention of death, myocardial infarction, and stroke in high risk patients. BMJ 324(7329):71–86

Lakhan SE & Sapko MT 2009. Blood pressure lowering treatment for preventing stroke recurrence: a systematic review and meta‑analysis. Internal Archives of Medicine 2(1):30

NSF (National Stroke Foundation) 2010. Clinical guidelines for stroke management. Melbourne: NSF

The Stroke Prevention by Aggressive Reduction in Cholesterol Levels (SPARCL) Investigators 2006. High-dose atorvastatin after stroke or transient ischemic attack. New England Journal of Medicine 355(6):549–559

Relational attributes

Related metadata references:Help on this term

See also Acute stroke clinical care standard indicators: 5a-Separation on antihypertensive medication for haemorrhagic stroke Health, Candidate 14/03/2017

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