Integrated Care Using the ABCstroke Pathway Improves Cardiovascular Outcomes and Survival in Patients with First-Ever Ischaemic Stroke
Background: A recent position paper of the European Society of Cardiology Council on Stroke proposed an integrated ABCstroke pathway to optimise post-stroke management. We evaluated the impact of ABCstroke pathway adherence on post-stroke cardiovascular outcomes. Methods: Patients with first-ever is...
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Ubiquity Press
2025-05-01
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| Series: | Global Heart |
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| Online Access: | https://account.globalheartjournal.com/index.php/up-j-gh/article/view/1430 |
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| author | Christopher T. W. Tsang Sylvia E. Choi Tommaso Bucci Jia-Yi Huang Qing-Wen Ren Mei-Zhen Wu Wen-Li Gu Ran Guo Jing-Nan Zhang Anthony O. T. Ma Steven H. M. Lam Yap-Hang Chan Kui-Kai Lau Hung-Fat Tse Azmil H. Abdul-Rahim Gregory Y. H. Lip Kai-Hang Yiu |
| author_facet | Christopher T. W. Tsang Sylvia E. Choi Tommaso Bucci Jia-Yi Huang Qing-Wen Ren Mei-Zhen Wu Wen-Li Gu Ran Guo Jing-Nan Zhang Anthony O. T. Ma Steven H. M. Lam Yap-Hang Chan Kui-Kai Lau Hung-Fat Tse Azmil H. Abdul-Rahim Gregory Y. H. Lip Kai-Hang Yiu |
| author_sort | Christopher T. W. Tsang |
| collection | DOAJ |
| description | Background: A recent position paper of the European Society of Cardiology Council on Stroke proposed an integrated ABCstroke pathway to optimise post-stroke management. We evaluated the impact of ABCstroke pathway adherence on post-stroke cardiovascular outcomes. Methods: Patients with first-ever ischaemic stroke in Hong Kong between 2006 and 2022 were included in this retrospective cohort study. Multivariable Cox regression analysis was performed to evaluate the association between physicians’ adherence to the ABCstroke pathway and the primary outcome, which was a composite of recurrent ischaemic stroke, transient ischaemic attack, haemorrhagic stroke, myocardial infarction, heart failure and all-cause mortality. Results: Of the 9,669 included patients with ischaemic stroke (mean age 69.6 ± 13.4 years; 57.5% male), 58.1% were optimally managed according to all three ABCstroke pillars. After 1 year of follow-up, adherence to the ABCstroke pathway was associated with a lower risk of the primary composite endpoint (hazard ratio (HR): 0.80; 95% confidence interval (CI): 0.72–0.88), as well as a lower risk of haemorrhagic stroke (subdistribution hazard ratio (SHR): 0.50; 95% CI: 0.38–0.67), heart failure (SHR: 0.771; 95% CI: 0.596–0.998), cardiovascular death (SHR: 0.64; 95% CI: 0.45–0.90), and all-cause mortality (HR: 0.72; 95% CI: 0.62–0.85). Risk reductions in the primary endpoint increased progressively with a higher number of ABCstroke criteria obtained. No significant interaction was observed in the association according to age, sex, or stroke severity. Conclusions: In this cohort of Asian patients with first-ever ischaemic stroke, optimal management according to the ABCstroke pathway was associated with a reduction in the risk of adverse outcomes. |
| format | Article |
| id | doaj-art-eec3e5b4709e4c45aa30e5bee6c49c81 |
| institution | OA Journals |
| issn | 2211-8179 |
| language | English |
| publishDate | 2025-05-01 |
| publisher | Ubiquity Press |
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| series | Global Heart |
| spelling | doaj-art-eec3e5b4709e4c45aa30e5bee6c49c812025-08-20T02:22:16ZengUbiquity PressGlobal Heart2211-81792025-05-01201464610.5334/gh.14301411Integrated Care Using the ABCstroke Pathway Improves Cardiovascular Outcomes and Survival in Patients with First-Ever Ischaemic StrokeChristopher T. W. Tsang0https://orcid.org/0000-0003-3394-6604Sylvia E. Choi1https://orcid.org/0000-0003-3012-8219Tommaso Bucci2https://orcid.org/0000-0003-2895-6234Jia-Yi Huang3Qing-Wen Ren4Mei-Zhen Wu5Wen-Li Gu6https://orcid.org/0000-0002-5640-9337Ran Guo7Jing-Nan Zhang8Anthony O. T. Ma9Steven H. M. Lam10https://orcid.org/0000-0003-2147-0995Yap-Hang Chan11Kui-Kai Lau12https://orcid.org/0000-0002-8657-2418Hung-Fat Tse13Azmil H. Abdul-Rahim14https://orcid.org/0000-0002-1318-4027Gregory Y. H. Lip15https://orcid.org/0000-0002-7566-1626Kai-Hang Yiu16https://orcid.org/0000-0003-2145-3108Cardiology Division, Department of Medicine, The University of Hong Kong, Hong KongLiverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool; Department of Cardiovascular and Metabolic Medicine, Institute of Life Course and Medical Sciences, University of Liverpool, LiverpoolLiverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool; Department of Cardiovascular and Metabolic Medicine, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK; Department of Clinical Internal, Anesthesiological and Cardiovascular Sciences, Sapienza University of Rome, RomeCardiology Division, Department of Medicine, The University of Hong Kong, Hong Kong; Cardiology Division, Department of Medicine, The University of Hong Kong Shen Zhen Hospital, Shen ZhenCardiology Division, Department of Medicine, The University of Hong Kong, Hong Kong; Cardiology Division, Department of Medicine, The University of Hong Kong Shen Zhen Hospital, Shen ZhenCardiology Division, Department of Medicine, The University of Hong Kong, Hong Kong; Cardiology Division, Department of Medicine, The University of Hong Kong Shen Zhen Hospital, Shen ZhenCardiology Division, Department of Medicine, The University of Hong Kong, Hong Kong; Cardiology Division, Department of Medicine, The University of Hong Kong Shen Zhen Hospital, Shen ZhenCardiology Division, Department of Medicine, The University of Hong Kong, Hong Kong; Cardiology Division, Department of Medicine, The University of Hong Kong Shen Zhen Hospital, Shen ZhenCardiology Division, Department of Medicine, The University of Hong Kong, Hong Kong; Cardiology Division, Department of Medicine, The University of Hong Kong Shen Zhen Hospital, Shen ZhenCardiology Division, Department of Medicine, The University of Hong Kong, Hong KongLiverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool; Department of Cardiovascular and Metabolic Medicine, Institute of Life Course and Medical Sciences, University of Liverpool, LiverpoolCardiology Division, Department of Medicine, The University of Hong Kong, Hong KongNeurology Division, Department of Medicine, The University of Hong Kong, Hong Kong; State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Hong KongCardiology Division, Department of Medicine, The University of Hong Kong, Hong KongLiverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool; Department of Cardiovascular and Metabolic Medicine, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool; Stroke Division, Department of Medicine for Older People, Whiston Hospital, Mersey and West Lancashire Teaching Hospitals NHS Trust, PrescotLiverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, UK; Danish Center for Health Services Research, Department of Clinical Medicine, Aalborg UniversityCardiology Division, Department of Medicine, The University of Hong Kong, Hong Kong; Cardiology Division, Department of Medicine, The University of Hong Kong Shen Zhen Hospital, Shen ZhenBackground: A recent position paper of the European Society of Cardiology Council on Stroke proposed an integrated ABCstroke pathway to optimise post-stroke management. We evaluated the impact of ABCstroke pathway adherence on post-stroke cardiovascular outcomes. Methods: Patients with first-ever ischaemic stroke in Hong Kong between 2006 and 2022 were included in this retrospective cohort study. Multivariable Cox regression analysis was performed to evaluate the association between physicians’ adherence to the ABCstroke pathway and the primary outcome, which was a composite of recurrent ischaemic stroke, transient ischaemic attack, haemorrhagic stroke, myocardial infarction, heart failure and all-cause mortality. Results: Of the 9,669 included patients with ischaemic stroke (mean age 69.6 ± 13.4 years; 57.5% male), 58.1% were optimally managed according to all three ABCstroke pillars. After 1 year of follow-up, adherence to the ABCstroke pathway was associated with a lower risk of the primary composite endpoint (hazard ratio (HR): 0.80; 95% confidence interval (CI): 0.72–0.88), as well as a lower risk of haemorrhagic stroke (subdistribution hazard ratio (SHR): 0.50; 95% CI: 0.38–0.67), heart failure (SHR: 0.771; 95% CI: 0.596–0.998), cardiovascular death (SHR: 0.64; 95% CI: 0.45–0.90), and all-cause mortality (HR: 0.72; 95% CI: 0.62–0.85). Risk reductions in the primary endpoint increased progressively with a higher number of ABCstroke criteria obtained. No significant interaction was observed in the association according to age, sex, or stroke severity. Conclusions: In this cohort of Asian patients with first-ever ischaemic stroke, optimal management according to the ABCstroke pathway was associated with a reduction in the risk of adverse outcomes.https://account.globalheartjournal.com/index.php/up-j-gh/article/view/1430strokepost-stroke careintegrated careabc pathwaycardiovascular outcomes |
| spellingShingle | Christopher T. W. Tsang Sylvia E. Choi Tommaso Bucci Jia-Yi Huang Qing-Wen Ren Mei-Zhen Wu Wen-Li Gu Ran Guo Jing-Nan Zhang Anthony O. T. Ma Steven H. M. Lam Yap-Hang Chan Kui-Kai Lau Hung-Fat Tse Azmil H. Abdul-Rahim Gregory Y. H. Lip Kai-Hang Yiu Integrated Care Using the ABCstroke Pathway Improves Cardiovascular Outcomes and Survival in Patients with First-Ever Ischaemic Stroke Global Heart stroke post-stroke care integrated care abc pathway cardiovascular outcomes |
| title | Integrated Care Using the ABCstroke Pathway Improves Cardiovascular Outcomes and Survival in Patients with First-Ever Ischaemic Stroke |
| title_full | Integrated Care Using the ABCstroke Pathway Improves Cardiovascular Outcomes and Survival in Patients with First-Ever Ischaemic Stroke |
| title_fullStr | Integrated Care Using the ABCstroke Pathway Improves Cardiovascular Outcomes and Survival in Patients with First-Ever Ischaemic Stroke |
| title_full_unstemmed | Integrated Care Using the ABCstroke Pathway Improves Cardiovascular Outcomes and Survival in Patients with First-Ever Ischaemic Stroke |
| title_short | Integrated Care Using the ABCstroke Pathway Improves Cardiovascular Outcomes and Survival in Patients with First-Ever Ischaemic Stroke |
| title_sort | integrated care using the abcstroke pathway improves cardiovascular outcomes and survival in patients with first ever ischaemic stroke |
| topic | stroke post-stroke care integrated care abc pathway cardiovascular outcomes |
| url | https://account.globalheartjournal.com/index.php/up-j-gh/article/view/1430 |
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