Risk of coronary heart disease and stroke based on United Kingdom prospective diabetes study in type 2 DM patients in Medan

Cardiovascular disease is one of the most prevalent diabetic consequences that can lead to death. The purpose of this study was to use The United Kingdom Prospective Diabetes Study (UKPDS) Risk Engine to determine the risk of CVD complications in type 2 DM patients. The study’s design is analytic using a cross-sectional approach, and the samples include 108 type 2 diabetes patients in Medan who fulfill the inclusion and exclusion criteria. The results showed that most patients had a high risk for CHD and a low risk for stroke. Education must be carried out intensively to patients that blood sugar is more controlled to reduce the risk of complications.

Abstract P286: The Effects of COVID-19 on the Reasons for Not Calling 911 for Acute Stroke

Objective: Our Stroke Program regularly provides community outreach and stroke education. The stroke team educates on signs and symptoms of stroke, risks factors, and 911 activation. Within a few days of discharge, Neuroscience nurses call stroke patients to ensure patients have obtained their prescription medications, have follow-up appointments, inquire about their satisfaction with our services, and reinforce stroke education. As part of these calls, our team asked why patients/families did not call 911. The purpose of this study was to determine if the COVID-19 crisis influenced the reasons why 911 was not called for possible stroke to better plan for targeted stroke education. Method: Discharge phone survey data from our stroke network was collected from Feb-Jul 2019 and compared to Feb-Jul 2020. Our stroke network includes 1 comprehensive stroke center and 2 primary stroke centers. Emergency Department (ED) stroke activation data was gathered for the same time periods. Discharge phone calls data was based on discharge date, whereas ED stroke alert data was based on admission date. Results: There was a notable decline in stroke volume between 2019 to 2020 with the largest decline occurring during the first peak (Apr 2020) in COVID-19 cases within our state. This decline was driven by a 16% decline in walk-in ED stroke arrivals as compared to a 1% decline in EMS stroke arrivals. Of those who did not call 911 in 2020, there was a 7% increase in failing to recognize stroke symptoms as an emergency, a 6% increase in concern about EMS cost, and 6% decrease in hospital preference. Conclusion: The COVID-19 crisis negatively influenced stroke volumes within our system stroke program. Reductions in stroke walk-ins accounted for this decline. COVID-19 affected the reasons why 911 was not called. The largest increase was in not recognizing stroke symptoms as an emergency and increased concern about EMS associated costs. Surprisingly, COVID-19 was not listed as a reasons for avoiding 911. Targeted community educational efforts on these concerns may lead to improved 911 usage for suspected stroke during the COVID-19 pandemic. Limitations: Further research is needed to investigate why those with a stroke who would have been walk-ins decided not to seek urgent medical attention.

Stroke Care in the First Affiliated Hospital of Chengdu Medical College during the COVID-19 Outbreak

Coronavirus disease-2019 (COVID-19) has become a pandemic disease globally. The First Affiliated Hospital of Chengdu Medical College has adopted telestroke to make stroke care accessible in remote areas. During the period January 2020 to March 2020, there was no COVID-19 case reported in our stroke center. A significant reduction of stroke admission was observed between the ischemic stroke group (235 vs. 588 cases) and the intracerebral hemorrhage group (136 vs. 150 cases) when compared with the same period last year (<i>p</i> &#x3c; 0.001). The mean door-to-needle time (DNT) and door-to-puncture time (DPT) was 62 and 124 min, respectively. Compared to the same period last year, a significant change was observed in DNT (62 ± 12 vs. 47 ± 8 min, <i>p</i> = 0.019) but not in DPT (124 ± 58 vs. 135 ± 23 min, <i>p</i> = 0.682). A total of 46 telestroke consultations were received from network hospitals. Telestroke management in the central hospital was performed on 17 patients. Of them, 3 (17.6%) patients had brain hernia and died in hospital and 8 (47.1%) patients were able to ambulation at discharge and had a modified Rankin Scale of 0–2 at 3 months. The COVID-19 pandemic impacted stroke care significantly in our hospital, including prehospital and in-hospital settings, resulting in a significant drop in acute ischemic stroke admissions and a delay in DNT. The construction of a telestroke network enabled us to extend health-care resources and make stroke care accessible in remote areas. Stroke education and public awareness should be reinforced during the COVID-19 pandemic.

Abstract TP375: Using Characteristics of Secondary Ischemic Stroke Events to Improve Stroke Education Initiatives

Purpose: While it is common practice for nursing to perform the duty of stroke education,it is not common to use secondary stroke event data to determine what aspect of stroke education should be emphasized for the greatest impact on secondary stroke prevention. The purpose of this descriptive study is to exam the characteristics of secondary stroke events using the TOAST (Trial of Org 10172 in Acute Stroke Treatment) criteria so future educational initiatives can be customized to the needs of the local high risk population. Methods: The team collected data characteristics on all ischemic stroke admissions with previous admitting diagnosis of acute ischemic stroke. The strokes were further characterized using the TOAST (Trial of Org 10172 in Acute Stroke Treatment) classification to determine any emerging patterns of both risk factors and etiological types. Conclusions: A total of n=51 admissions were previous adult stroke survivors, (M=30, F=21). Pre-morbid risk factors were as follows: hypertension=78%, type 2 diabetes=39%, hyperlipidemia =54%, smoking=8%, atrial fibrillation=24%. TOAST classification results: Large Vessel Atherosclerosis=14%, Cardioembolic =17%, Small Vessel Disease=3%, Other Known Cause=2%, Cryptogenic=15%. Summary: The results reveal a striking pattern of the presence of premorbid hypertension. While the TOAST classification did not have a single dominant type, but nearly equal distribution of large vessel atherosclerosis, cardioembolic, and small vessel disease etiologies. Not surprising, the decline in stroke mortality is felt to be due to improved blood pressure control, but in discharge stroke education, hypertension is not necessarily emphasized over other perhaps less impactful risk factors. Yet, the most recent acute ischemic stroke clinical guidelines gave providers a first-time recommendation to start or restart antihypertensive therapy in stable patients with BP > 140/90. Nursing has enough encouragement to take the lead on hypertension prevention education in appropriate stable patients ready for discharge. The next goal will be to develop a multimedia educational effort in patient stroke education on hypertension as a risk factor for secondary stroke prevention in this Comprehensive Stroke Center.

Abstract TP355: A Valiant Effort to Improve Stroke Education

Background and Purpose: Increasing knowledge of pertinent aspects of stroke disease may improve outcomes for stroke survivors and family members. Patients and families are educated in a large integrated health system on Joint Commission required elements of stroke education which include: importance of calling 911, stroke signs and symptoms, disease processes, risk factor management, and follow up. In 2018, despite 95% documented rates of education, 40 to 50% of stroke survivors in the health system replied “No” to three Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPs) "staff explained stroke..." questions. The purpose of this project was to improve stroke education as measured by an increase in HCAHPs scores. Methods: Current literature was reviewed. Stroke survivors spoke to a regional stroke coordinator group about their experiences. Staff nurses were surveyed on barriers to stroke education. Based on information from the literature, stroke survivors, staff nurses and neuroscience nursing, neurology and education experts, two interventions were undertaken. A flyer was designed using a well-spaced layout with required stroke education elements written at fourth grade reading level and translated into four common languages in the patient population. Community feedback was integrated after the initial design. A training module for teaching stroke education was completed by 886 nurses in eight facilities. The pre and post intervention HCAHPs scores were aggregated from the eight hospitals. The results were analyzed using a Chi2 statistical tool. Results: Unfortunately, a statistically significant increase in HCAHPs scores was not achieved. For question #1; “staff explained stroke diagnosis”, the percentage yes went from %53 (n=49) to %59 (n=59). Question #2; “staff explained risk factors” went from %52 (n=50) to %43 (n=58). Question #3 “staff explained stroke signs/symptoms” went from %47 (n=48) to %53 (n=69). Conclusion: This work supports literature and local stroke survivor feedback indicating stroke survivors and their families are too overwhelmed in the hospital to absorb education. Resources should be put into follow-up phone calls or other modalities after trauma from the stroke event has subsided.

Abstract WP438: Monthly Patient Stroke Education Prevalence Rounds Increase Nursing Engagement While Positively Affecting Quality Patient Outcomes

Background and Purpose: Understanding stroke and factors in the prevention of stroke are fundamental in improving quality outcomes and patient healthcare compliance. Daily individualized patient education is an accreditation requirement, and as a certified stroke center the goal is to exceed national care standards for patients with stroke. Documentation of daily individualized patient education compliance was found to be below the required expectations with initial audits. Bedside nurses were surveyed on documentation requirements of every stroke patient, and a knowledge gap was identified. The purpose of this quality initiative was to improve compliance of daily individualized stroke education and increase bedside nursing accountability and engagement in the care of stroke patients. Methods: The quality initiative consisted of a monthly one day snapshot of daily stroke education documentation compliance (average n=34). Results are shared with executive nursing leadership, unit managers and bedside nurses. Stroke Champions facilitate one-on-one education with their nursing peers when opportunities for improvement of required stroke education have been identified. This nurse driven collaboration was augmented with daily education reminders during unit huddles, patient stroke education posters on the unit, and caregiver award recognition for those nurses with high compliance. Results: Significant improvements in documentation of daily individualized stroke education were found following the stroke prevalence education initiative. A pre-initiative audit was conducted 4th quarter of 2015, revealing compliance was at 65%. After implementation, 2016 compliance improved to an overall 86%; 2017 was 84%; 2018 was 90% and the first half of 2019 remains at 90%. Conclusions: In conducting monthly stroke prevalence rounds, nurse driven collaboration has shown significant improvements in consistently documenting daily individualized stroke education, therefore increasing required patient stroke education compliance and producing the potential for better outcomes for patients.