Adherence to American Heart Association/American Stroke Association Clinical Performance Measures in a Peruvian Neurological Reference Institute

Carlos Abanto, Angela K. Ulrich, Ana Valencia, Víctor Dueñas, Silvia Montano, David Tirschwell, Joseph Zunt

Research output: Contribution to journalArticlepeer-review

5 Scopus citations


BACKGROUND: Little is known about adherence to American Heart Association/American Stroke Association (AHA/ASA) stroke performance measures in developing countries like Peru.

AIMS: We assessed adherence and determined factors associated with adherence to the AHA/ASA stroke performance measures at a reference center for neurological diseases in Lima, Peru.

METHODS: We conducted a retrospective chart review of 150 stroke patients admitted to the Neurological Institute of Neurological Science from 2014 to 2016 to ascertain adherence to 15 different AHA/ASA stroke performance measures. Adherence was measured as a simple proportion, with both single and composite measures. Associations were analyzed with nonparametric statistics and multivariate logistic regression.

RESULTS: Mean adherence to AHA/ASA stroke performance measures was 47%. We observed a statistically significant relationship between adherence to ischemic stroke performance measures and being married (OR = 3.78, 95% CI: 1.05-13.55), as well as an inverse relationship with an onset of symptoms of greater than 4.5 h prior to arrival at the hospital compared to those with ≤ 4.5 h (OR = 0.14, 95% CI: 0.02-0.97). Compared to patients with a lower National Institutes of Health Stroke Scale (NIHSS) score (<13), those with a score of ≥13 were less likely to have good adherence (OR = 0.11, 95% CI: 0.04-0.31).

CONCLUSIONS: The mean composite measure of adherence to internationally recognized standards of stroke management in our Peruvian institution was below the level needed for an achievement award by AHA/ASA. An intervention targeted toward stroke prevention and training could lead to improved outcomes of stroke patients in Peru.

Original languageEnglish (US)
Article number105285
JournalJournal of Stroke and Cerebrovascular Diseases
Issue number11
StatePublished - Nov 2020

Bibliographical note

Funding Information:
Grant support: Research reported in this publication was supported by the Fogarty International Center of the National Institutes of Health under Award Number D43 TW009137

Publisher Copyright:
© 2020 Elsevier Inc.


  • Adherence to AHA/ASA measures
  • Clinical performance measures
  • Ischemic stroke
  • Stroke performance measures
  • United States
  • Humans
  • Middle Aged
  • Practice Patterns, Physicians'/standards
  • Brain Ischemia/diagnosis
  • Neurologists/standards
  • Male
  • Quality Indicators, Health Care/standards
  • Young Adult
  • Outcome and Process Assessment, Health Care/standards
  • Adult
  • Female
  • Retrospective Studies
  • Stroke/diagnosis
  • Treatment Outcome
  • American Heart Association
  • Guideline Adherence/standards
  • Practice Guidelines as Topic/standards
  • Aged
  • Developing Countries
  • Peru

PubMed: MeSH publication types

  • Journal Article


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