RT Journal Article
SR Electronic
T1 Hospital admissions for stroke and bleeding in Hounslow following a quality improvement initiative
JF Open Heart
JO Open Heart
FD British Cardiovascular Society
SP e001558
DO 10.1136/openhrt-2020-001558
VO 8
IS 1
A1 Kam Ying Wong
A1 Bethan Davies
A1 Yewande Adeleke
A1 Thomas Woodcock
A1 Dionne Matthew
A1 Sara Sekelj
A1 Andi Orlowski
A1 Bradley Porter
A1 Sophia Hashmy
A1 Ammu Mathew
A1 Ron Grant
A1 Agnes Kaba
A1 Brigitte Unger-Graeber
A1 Bruno Petrungaro
A1 Jordan Wallace
A1 Derek Bell
A1 Martin R Cowie
A1 Sadia Khan
YR 2021
UL http://openheart.bmj.com/content/8/1/e001558.abstract
AB 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.All data relevant to the study are included in the article or uploaded as supplementary information.