Background:
Hospitalists are frequently the primary providers of inpatient stroke care despite an underemphasis on neurology in traditional internal medicine training. Treatment attitudes and practices of hospitalists pertaining to stroke are unclear.
Methods:
A survey was developed focusing on 3 areas of stroke care: (1) relationships between hospitalists and neurologists, (2) views on both intravenous tissue plasminogen activator (IV TPA) and IV heparin in acute stroke, and (3) secondary prevention. The Society of Hospital Medicine sent 2062 surveys to its membership. Two hundred and six complete responses were received via the Zoomerang online survey service.
Results:
A minority of hospitalists, 82 (40%), consulted a neurologist on all ischemic stroke patients, and 69 (34%) had difficulty accessing a neurologist at their hospital. Only 20 (10%), however, believed that a neurologist needs to be involved in all cases, with an additional 56 (27%) believing that most should be seen by a neurologist. Interestingly, only 111 (54%) reported that stroke care was better if a neurologist was involved as well as a hospitalist, as opposed to the 174 (84%) who stated that stroke care was improved by the involvement of a hospitalist in addition to a neurologist's involvement. Fifty percent of respondents would use heparin in acute stroke with atrial fibrillation. The vast majority, 188 (91%), thought that IV TPA is a proven treatment for acute stroke. One hundred and eighty‐three (90%) would prescribe a statin to a patient with symptomatic 60% carotid narrowing with an LDL of 95 mg/dL. One hundred and twenty‐three (60%) would randomize an asymptomatic patient with 60%‐99% stenosis to medical therapy versus carotid endarterectomy. Twelve percent of hospitalists would prescribe an increased dose of aspirin for secondary prevention for an “aspirin failure” patient, whereas 23% would change to clopidogrel and 63% would use ASA/extended‐release dipyridamole.
Conclusions:
Most hospitalists who completed this survey felt comfortable caring for stroke patients without a neurology consultation. Neurological consultation was not readily available for many, but it was also thought not to improve patient care in some instances. A significant majority of the hospitalists had accepted IV TPA as a valuable treatment for stroke, in contrast with their emergency medicine colleagues (40% acceptance in a 2005 survey). There was considerable variability in treatment scenarios addressing controversial topics, including IV heparin use. An analogous survey of neurologists is planned.
Author Disclosure:
D. Likosky, none; A. Amin, none; S. Chaturvedi, Boehringer‐Ingelheim, speakers bureau, research funding; BMS/ sanofi, speakers bureau; Bayer, research funding; Schering, research funding.