Medical centers with more experience with aggressive medical management had a significantly positive impact on patient outcomes, according to a study conducted by Houston Methodist Hospital and five partner institutions that used data from a major stroke clinical study. The research was recently published in the journal American Academy of Neurology.

Dr. David Chiu, medical director of the Houston Methodist Eddy Scurlock Stroke Center, and neurologist at the Houston Methodist Neurological Institute, was the lead investigator on a study that investigated the effectiveness of aggressive medical management compared to stenting for stroke patients.

This research, dubbed SAMMPRIS, for Stenting and Aggressive Medical Management for the Prevention of Recurrent Ischemic Stroke, involved five partner institutions and was funded by the National Institutes of Health. The randomized controlled trial was conducted at 50 institutions between 2008 and 2013 and included a total enrollment of 451 patients.
The study found that aggressive medical management resulted in lower rates of stroke recurrence and mortality in patients who had experienced transient ischemic attacks (TIAs), but Chiu wanted to dig a little deeper. Chiu said, “We know that medical therapy is better, but what I wanted to find out is: Are results from medical therapy uniform across centers? Is there some potential effect of the interventionists’ experience and track record? Is the success of the treatment operator dependent?”

Since all the stroke centers were following the same standardized protocol for medical management, Chiu and his team evaluated whether patients treated at centers with more experienced clinicians and treating a higher volume of patients fared better overall.

The research team found that after 30 days of medical management, patients at high volume centers had only a 1.8 percent rate of recurrence or death, while patients at lower volume centers had a 9.8 percent rate of recurrence or death. After two years, the statistics for high volume centers were 7.3 percent versus 20.9 percent at the lower volume centers.

Chiu explained the difference in outcomes this way: “There was a protocol that each center was supposed to adhere to and each center did their best but (our data) speak to the fact that the aggressive medical management protocol that is widely recognized as the benchmark is not something you can take for granted that will go smoothly regardless of the effort of the clinician to adhere to it. Data shows that these components are dependent on the training and adherence of clinicians and support staff and getting the buy-in of patients.”

Chiu added that the outcomes of the study point to the need to enhance training and clinician skills at the lower volume stroke centers, as well as the need for consumers to consider the benefits of seeking care at a stroke center treating a high volume of patients.

“We need to pay attention to how we train clinical care providers in delivery of the protocol. The ideal is to bring the level of care up in low volume centers to match their high volume counterparts. The more institutions that can provide this high level of care, the better. The consumer wants to go to a center that has good outcomes. Patients should shop around for the centers that have the best outcomes."

Emergency Medicine Homepage