Get With the Guidelines Program Launched in China to Improve Stroke Outcomes
July 6, 2017—The American Heart Association/American Stroke Association (AHA/ASA) announced a collaboration with the Chinese Stroke Association (CSA) to launch a quality improvement program adapted from the AHA's guidelines-based program, Get With the Guidelines (GWTG), with the aim of delivering significant, positive stroke outcomes in the world's largest population.
The program, which has been in effect for 15 years in the United States, works to improve the treatment for and prevention of cardiovascular and stroke events by helping hospitals and providers consistently adhere to the latest scientific treatment guidelines. GWTG has transformed patient care for heart and stroke patients in the United States, helping hospitals and providers learn the correct treatment and translate guidelines into practice, stated the AHA/ASA.
In China, the adapted GWTG program, designed through a collaboration of the ASA and the CSA, endorsed by the China National Health and Family Planning Commission, and supported by Medtronic, is a set of best practices that aim to continuously improve treatment, enhance the quality of care, and prevent future stroke events in China.
The collaboration's priority is to reach health care providers with the GWTG program at Chinese secondary and tertiary hospitals and at all stages of the chain of survival, from prehospital advanced medical care (or emergency medical services [EMS]) to neurologists, and even to hospital administrators.
In China, the program addresses the need for:
1. Enhanced education for EMS and prehospital caregivers, especially since analysis shows that only 13% of Chinese stroke patients arrive at the hospital by EMS versus 50% in the United States.
2. A reduction in door-to-needle times for patients to receive tissue plasminogen activator (tPA). To date, analysis for rates of compliance with evidence-based therapies notes significant gaps in timeliness to tPA treatment.
3. Increased awareness and application of mechanical endovascular reperfusion therapies in appropriate patients.
4. Increased awareness and application of secondary prevention in appropriate stroke patients to fill significant gaps in venous thromboembolism prophylaxis, lipid-lowering therapy, anticoagulation for atrial fibrillation, and rehabilitation assessment in Chinese patients.
According to the AHA/ASA, stroke is the leading cause of death that claims the lives of 1.6 million Chinese people annually. China faces cardiovascular and stroke risk factors similar to those in Western nations. Among the risk factors, hypertension remains the most important for all types of strokes. Additionally, the concept of a "stroke belt" in China has emerged and identifies specific geographic regions where the mortality associated with stroke is 50% higher than that of other regions in the country. Currently, the highest mortality rates are seen in the Northeast and the West/Southwest areas of China.
Stroke has also had a significant impact on health care expenditures and the Chinese economy. The cost for stroke care by the government-funded hospitals was 1.17 billion RMB (approximately $170 million USD) in 2003 and 8.19 billion RMB (approximately $1.3 billion USD) in 2009, a 117% increase annually. Now, the annual cost of stroke care in China is approximately 40 billion RMB ($5.8 billion USD).
In 2007, the Ministry of Health—now National Health and Family Planning Commission—sponsored the Chinese National Stroke Registry and a 5-year plan to increase comprehensive stroke centers in China. Establishing the registry also led to creating the Stroke Screening, Prevention and Treatment Project in 2009 and, more recently, the National Center of Stroke Care Quality Control in 2011.
Ying Xian, MD, spokesperson for the ASA, commented in the announcement, "The ASA is deeply committed to having a transformative impact on health care systems and patients worldwide by working alongside countries, governments, and international cardiovascular and cerebrovascular societies to facilitate the application of the tools and knowledge of our quality programs. The United States marketplace has given us a road map to develop scalable and sustainable models for international quality improvement initiatives. Now, with our consult, the Chinese Stroke Association aims to adopt those models to achieve better outcomes for stroke patients in China." Dr. Xian is Assistant Professor of Neurology and Medicine at the Duke University Medical Center and Duke Clinical Research Institute in Durham, North Carolina.
CSA President Jizong Zhao, stated, "It is with great excitement that we announce the launch of this collaborative stroke quality improvement project between the CSA and ASA to further enhance cooperation on clinical research, education, and the impact of acute stroke science. I congratulate both organizations' dedication to improving stroke outcomes in China."
Chris Lee, President of Medtronic Greater China, added, "Medtronic is a leading stroke care solution provider in stent retriever therapy with more than 20 years of experience in China. We provide clinical education and training systems for Chinese physicians and, together with medical societies, we consistently promote a hierarchical treatment system, raise public awareness, and speed up patient admission and treatment to ensure the proper care for patients. We are very proud to collaborate with both the CSA and ASA, and we will continuously work together to improve China's stroke care quality."