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Mortality Reduction for Fever, Hyperglycemia, and Swallowing Nurse-Initiated Stroke Intervention: QASC Trial (Quality in Acute Stroke Care) Follow-Up

Middleton, Sandy; Coughlan, Kelly; Mnatzaganian, George; Low Choy, Nancy L.; Dale, Simeon; Jammali-Blasi, Asmara; Levi, Christopher; Grimshaw, Jeremy M; Ward, Jeanette Elizabeth; Cadilhac, Dominique; McElDuff, Patrick; Hiller, J E; D'Este, Catherine

Description

Background and Purpose - Implementation of nurse-initiated protocols to manage fever, hyperglycemia, and swallowing dysfunction decreased death and disability 90 days poststroke in the QASC trial (Quality in Acute Stroke Care) conducted in 19 Australian acute stroke units (2005-2010). We now examine long-term all-cause mortality. Methods - Mortality was ascertained using Australia's National Death Index. Cox proportional hazards regression compared time to death adjusting for correlation within...[Show more]

dc.contributor.authorMiddleton, Sandy
dc.contributor.authorCoughlan, Kelly
dc.contributor.authorMnatzaganian, George
dc.contributor.authorLow Choy, Nancy L.
dc.contributor.authorDale, Simeon
dc.contributor.authorJammali-Blasi, Asmara
dc.contributor.authorLevi, Christopher
dc.contributor.authorGrimshaw, Jeremy M
dc.contributor.authorWard, Jeanette Elizabeth
dc.contributor.authorCadilhac, Dominique
dc.contributor.authorMcElDuff, Patrick
dc.contributor.authorHiller, J E
dc.contributor.authorD'Este, Catherine
dc.date.accessioned2021-08-16T06:04:49Z
dc.identifier.issn0039-2499
dc.identifier.urihttp://hdl.handle.net/1885/243949
dc.description.abstractBackground and Purpose - Implementation of nurse-initiated protocols to manage fever, hyperglycemia, and swallowing dysfunction decreased death and disability 90 days poststroke in the QASC trial (Quality in Acute Stroke Care) conducted in 19 Australian acute stroke units (2005-2010). We now examine long-term all-cause mortality. Methods - Mortality was ascertained using Australia's National Death Index. Cox proportional hazards regression compared time to death adjusting for correlation within stroke units using the cluster sandwich (Huber-White estimator) method. Primary analyses included treatment group only unadjusted for covariates. Secondary analysis adjusted for age, sex, marital status, education, and stroke severity using multiple imputation for missing covariates. Results - One thousand and seventy-six participants (intervention n=600; control n=476) were followed for a median of 4.1 years (minimum 0.3 to maximum 70 months), of whom 264 (24.5%) had died. Baseline demographic and clinical characteristics were generally well balanced by group. The QASC intervention group had improved long-term survival (>20%), but this was only statistically significant in adjusted analyses (unadjusted hazard ratio [HR], 0.79; 95% confidence interval [CI], 0.58-1.07; P=0.13; adjusted HR, 0.77; 95% CI, 0.59-0.99; P=0.045). Older age (75-84 years; HR, 4.9; 95% CI, 2.8-8.7; P<0.001) and increasing stroke severity (HR, 1.5; 95% CI, 1.3-1.9; P<0.001) were associated with increased mortality, while being married (HR, 0.70; 95% CI, 0.49-0.99; P=0.042) was associated with increased likelihood of survival. Cardiovascular disease (including stroke) was listed either as the primary or secondary cause of death in 80% (211/264) of all deaths. Conclusions - Our results demonstrate the potential long-term and sustained benefit of nurse-initiated multidisciplinary protocols for management of fever, hyperglycemia, and swallowing dysfunction. These protocols should be a routine part of acute stroke care
dc.description.sponsorshipThis study was funded by an Australian Catholic University Faculty of Health Sciences grant. The original QASC Trial was funded by a National Health and Medical Research Council (NHMRC) Project Grant 353803 (2005–2010).
dc.format.mimetypeapplication/pdf
dc.language.isoen_AU
dc.publisherLippincott Williams & Wilkins
dc.rights© 2017 American Heart Association, Inc
dc.sourceStroke
dc.subjectfever
dc.subjecthyperglycemia
dc.subjectimplementation
dc.subjectmortality
dc.subjectstroke
dc.subjectswallowing
dc.titleMortality Reduction for Fever, Hyperglycemia, and Swallowing Nurse-Initiated Stroke Intervention: QASC Trial (Quality in Acute Stroke Care) Follow-Up
dc.typeJournal article
local.description.notesImported from ARIES
local.identifier.citationvolume48
dc.date.issued2017
local.identifier.absfor111706 - Epidemiology
local.identifier.absfor111003 - Clinical Nursing: Secondary (Acute Care)
local.identifier.absfor111709 - Health Care Administration
local.identifier.ariespublicationa383154xPUB5734
local.publisher.urlhttps://www.ahajournals.org/
local.type.statusPublished Version
local.contributor.affiliationMiddleton, Sandy, Australian Catholic University
local.contributor.affiliationCoughlan, Kelly, Australian Catholic University, St Vincent's Health Australia (Sydney) and School of Nursing
local.contributor.affiliationMnatzaganian, George, La Trobe University, College of Sciences
local.contributor.affiliationLow Choy, Nancy L., Australian Catholic University, St Vincent's Health Australia (Sydney) and School of Nursing
local.contributor.affiliationDale , Simeon , Australian Catholic University Sydney New South Wales
local.contributor.affiliationJammali-Blasi, Asmara, Australian Catholic University
local.contributor.affiliationLevi, Christopher, John Hunter Hospital
local.contributor.affiliationGrimshaw, Jeremy M, University of Ottawa
local.contributor.affiliationWard, Jeanette Elizabeth, University of Ottawa, Canada, Public Health and Preventive Medicine
local.contributor.affiliationCadilhac, Dominique, Monash University
local.contributor.affiliationMcElDuff, Patrick, University of Newcastle
local.contributor.affiliationHiller, J E, University of Adelaide
local.contributor.affiliationD'Este, Catherine, College of Health and Medicine, ANU
local.description.embargo2099-12-31
dc.relationhttp://purl.org/au-research/grants/nhmrc/353803
local.bibliographicCitation.issue5
local.bibliographicCitation.startpage1331
local.bibliographicCitation.lastpage1336
local.identifier.doi10.1161/STROKEAHA.116.016038
local.identifier.absseo920208 - Health Policy Evaluation
local.identifier.absseo920210 - Nursing
local.identifier.absseo920204 - Evaluation of Health Outcomes
dc.date.updated2020-11-23T10:50:45Z
local.identifier.scopusID2-s2.0-85017257343
local.identifier.thomsonID000401818400041
CollectionsANU Research Publications

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