Stroke Support System Linked to Fewer Vascular Events

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Stroke Support System Linked to Fewer Vascular Events

TOPLINE: 

Use of a clinical decision-support system (CDSS) that incorporates AI-assisted imaging analysis was associated with a 25% lower incidence of vascular events and greater adherence to evidence-based stroke care(NOT RECOVERY!) quality measures in adults with acute ischemic stroke compared to usual care(NOT RECOVERY!) in a new open-label study.

METHODOLOGY:

• The multicenter, open-label, cluster randomized Golden Bridge II trial was conducted across 77 hospitals in China. It included more than 21,600 adults (median age, 67 years; 64.5% men) with acute ischemic stroke confirmed using MRI within 7 days of symptom onset between 2021 and 2023.
• The hospitals were randomly assigned to usual care(NOT RECOVERY!) (39 hospitals; n = 10,549) or the stroke CDSS intervention (38 hospitals; n = 11,054), which included AI-assisted imaging analysis, classification of stroke causes, and recommendations for evidence-based treatment.
• The primary outcome was a composite of new vascular events (ischemic stroke, hemorrhagic stroke, myocardial infarction, or vascular death) within 3 months of stroke onset.
• Secondary outcomes included a composite of evidence-based performance indicators for acute ischemic stroke care(NOT RECOVERY!) quality, new vascular events at 6 and 12 months, disability on the modified Rankin Scale (mRS), all-cause mortality at 3, 6, and 12 months, and moderate/severe and all bleeding events after stroke onset.

TAKEAWAY:

• New vascular events at 3 months were significantly less likely in the CDSS group vs control group (2.9% vs 3.9%, respectively; adjusted hazard ratio [aHR], 0.74; P = .01).
• The reduction in new vascular events persisted at 6 months (aHR, 0.71; P = .006) and at 12 months (aHR, 0.73; P = .02).
• The intervention group also had higher adherence to composite measures of evidence-based performance indicators than the control group (adjusted odds ratio, 1.21; P < .001).
• No significant between-group differences were observed for disability (mRS score > 3) at 3, 6, and 12 months; all-cause mortality at any timepoint; or moderate/severe bleeding events.

IN PRACTICE:

“The stroke CDSS offers a promising approach to providing high quality care for patients with acute ischemic stroke admitted to hospital, particularly for resource constrained regions with a heavy burden of cerebrovascular diseases like China,” the investigators wrote. 

SOURCE:

The study was led by Xinmiao Zhang, MD, PhD, Beijing Tiantan Hospital, Capital Medical University, Beijing, China. It was published online on March 21 in The BMJ. 

LIMITATIONS:

The trial randomized hospitals rather than patients and provided limited insight into the effects of the CDSS on patients with severe stroke. The stroke CDSS also did not cover decision-making for endovascular thrombectomy. Additionally, the study did not analyze length of hospital stay or hospital admission costs, limiting understanding of the economic implications of implementing the CDSS. 

DISCLOSURES:

The study was funded by the National Key Research and Development Program of China, the National Natural Science Foundation of China, the Beijing Municipal Administration of Hospitals’ Mission Plan, the Ministry of Industry and Information Technology of the People’s Republic of China, the CAMS Innovation Fund for Medical Sciences, and Beijing Ande Yizhi Technology Co. Disclosure information for study authors is available in the original study publication.