Hospital admissions for stroke and bleeding in Hounslow following a quality improvement initiative
Objective Atrial fibrillation (AF) is the most common arrhythmia. Undiagnosed and poorly managed AF increases risk of stroke. The Hounslow AF quality improvement (QI) initiative was associated with improved quality of care for patients with AF through increased detection of AF and appropriate antico...
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| Format: | Article |
| Language: | English |
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BMJ Publishing Group
2021-02-01
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| Series: | Open Heart |
| Online Access: | https://openheart.bmj.com/content/8/1/e001558.full |
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| author | Martin R Cowie Bethan Davies Thomas Woodcock Derek Bell Yewande Adeleke Dionne Matthew Bradley Porter Sophia Hashmy Ammu Mathew Ron Grant Agnes Kaba Brigitte Unger-Graeber Sadia Khan Andi Orlowski Bruno Petrungaro Kam Ying Wong Sara Sekelj Jordan Wallace |
| author_facet | Martin R Cowie Bethan Davies Thomas Woodcock Derek Bell Yewande Adeleke Dionne Matthew Bradley Porter Sophia Hashmy Ammu Mathew Ron Grant Agnes Kaba Brigitte Unger-Graeber Sadia Khan Andi Orlowski Bruno Petrungaro Kam Ying Wong Sara Sekelj Jordan Wallace |
| author_sort | Martin R Cowie |
| collection | DOAJ |
| description | Objective Atrial fibrillation (AF) is the most common arrhythmia. Undiagnosed and poorly managed AF increases risk of stroke. The Hounslow AF quality improvement (QI) initiative was associated with improved quality of care for patients with AF through increased detection of AF and appropriate anticoagulation. This study aimed to evaluate whether there has been a change in stroke and bleeding rates in the Hounslow population following the QI initiative.Methods Using hospital admissions data from January 2011 to August 2018, interrupted time series analysis was performed to investigate the changes in standardised rates of admission with stroke and bleeding, following the start of the QI initiative in October 2014.Results There was a 17% decrease in the rate of admission with stroke as primary diagnosis (incidence rate ratio (IRR) 0.83; 95% CI 0.712 to 0.963; p<0.014). There was an even larger yet not statistically significant decrease in admission with stroke as primary diagnosis and AF as secondary diagnosis (IRR 0.75; 95% CI 0.550 to 1.025; p<0.071). No significant changes were observed in bleeding admissions. For each outcome, an additional regression model including both the level change and an interaction term for slope change was created. In all cases, the slope change was small and not statistically significant.Conclusion Reduction in stroke admissions may be associated with the AF QI initiative. However, the immediate level change and non-significant slope change suggests a lack of effect of the intervention over time and that the decrease observed may be attributable to other events. |
| format | Article |
| id | doaj-art-4dab53a7a32e46e599ab13633b1b5938 |
| institution | OA Journals |
| issn | 2053-3624 |
| language | English |
| publishDate | 2021-02-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | Open Heart |
| spelling | doaj-art-4dab53a7a32e46e599ab13633b1b59382025-08-20T02:13:53ZengBMJ Publishing GroupOpen Heart2053-36242021-02-018110.1136/openhrt-2020-001558Hospital admissions for stroke and bleeding in Hounslow following a quality improvement initiativeMartin R Cowie0Bethan Davies1Thomas Woodcock2Derek Bell3Yewande Adeleke4Dionne Matthew5Bradley Porter6Sophia Hashmy7Ammu Mathew8Ron Grant9Agnes Kaba10Brigitte Unger-Graeber11Sadia Khan12Andi Orlowski13Bruno Petrungaro14Kam Ying Wong15Sara Sekelj16Jordan Wallace17professor of cardiologyCardiology, West Middlesex University Hospital, London, UKDepartment of Primary Care and Public Health, Imperial College London, London, UK8 Imperial College London Department of Primary Care and Public Health, London, UKDepartment of Primary Care and Public Health, Imperial College London, London, UKKHP Cardiovascular & Respiratory Partnership, Guy`s and St Thomas` NHS Foundation Trust, London, UKKing`s College London, London, UKNorth West London Clinical Commissioning Group, London, UKCardiology, West Middlesex University Hospital, London, UKUpbeat Heart Prevention and Support Group, London, UKCardiology, West Middlesex University Hospital, London, UKChiswick Health Practice, London, UK2Imperial College LondonSchool of Public Health, Imperial College London, London, UKImperial College Health Partners, London, UKDepartment of Primary Care and Public Health, Imperial College London, London, UKImperial College Health Partners, London, UKPediatrics, Seattle Children`s Hospital, Seattle, Washington, USAObjective Atrial fibrillation (AF) is the most common arrhythmia. Undiagnosed and poorly managed AF increases risk of stroke. The Hounslow AF quality improvement (QI) initiative was associated with improved quality of care for patients with AF through increased detection of AF and appropriate anticoagulation. This study aimed to evaluate whether there has been a change in stroke and bleeding rates in the Hounslow population following the QI initiative.Methods Using hospital admissions data from January 2011 to August 2018, interrupted time series analysis was performed to investigate the changes in standardised rates of admission with stroke and bleeding, following the start of the QI initiative in October 2014.Results There was a 17% decrease in the rate of admission with stroke as primary diagnosis (incidence rate ratio (IRR) 0.83; 95% CI 0.712 to 0.963; p<0.014). There was an even larger yet not statistically significant decrease in admission with stroke as primary diagnosis and AF as secondary diagnosis (IRR 0.75; 95% CI 0.550 to 1.025; p<0.071). No significant changes were observed in bleeding admissions. For each outcome, an additional regression model including both the level change and an interaction term for slope change was created. In all cases, the slope change was small and not statistically significant.Conclusion Reduction in stroke admissions may be associated with the AF QI initiative. However, the immediate level change and non-significant slope change suggests a lack of effect of the intervention over time and that the decrease observed may be attributable to other events.https://openheart.bmj.com/content/8/1/e001558.full |
| spellingShingle | Martin R Cowie Bethan Davies Thomas Woodcock Derek Bell Yewande Adeleke Dionne Matthew Bradley Porter Sophia Hashmy Ammu Mathew Ron Grant Agnes Kaba Brigitte Unger-Graeber Sadia Khan Andi Orlowski Bruno Petrungaro Kam Ying Wong Sara Sekelj Jordan Wallace Hospital admissions for stroke and bleeding in Hounslow following a quality improvement initiative Open Heart |
| title | Hospital admissions for stroke and bleeding in Hounslow following a quality improvement initiative |
| title_full | Hospital admissions for stroke and bleeding in Hounslow following a quality improvement initiative |
| title_fullStr | Hospital admissions for stroke and bleeding in Hounslow following a quality improvement initiative |
| title_full_unstemmed | Hospital admissions for stroke and bleeding in Hounslow following a quality improvement initiative |
| title_short | Hospital admissions for stroke and bleeding in Hounslow following a quality improvement initiative |
| title_sort | hospital admissions for stroke and bleeding in hounslow following a quality improvement initiative |
| url | https://openheart.bmj.com/content/8/1/e001558.full |
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