Integrated Care Using the ABCstroke Pathway Improves Cardiovascular Outcomes and Survival in Patients with First-Ever Ischaemic Stroke

Background: A recent position paper of the European Society of Cardiology Council on Stroke proposed an integrated ABC_stroke pathway to optimise post-stroke management. We evaluated the impact of ABC_stroke pathway adherence on post-stroke cardiovascular outcomes.

Methods: Patients with first-ever ischaemic stroke in Hong Kong between 2006 and 2022 were included in this retrospective cohort study. Multivariable Cox regression analysis was performed to evaluate the association between physicians’ adherence to the ABC_stroke pathway and the primary outcome, which was a composite of recurrent ischaemic stroke, transient ischaemic attack, haemorrhagic stroke, myocardial infarction, heart failure and all-cause mortality.

Results: Of the 9,669 included patients with ischaemic stroke (mean age 69.6 ± 13.4 years; 57.5% male), 58.1% were optimally managed according to all three ABC_stroke pillars. After 1 year of follow-up, adherence to the ABC_stroke pathway was associated with a lower risk of the primary composite endpoint (hazard ratio (HR): 0.80; 95% confidence interval (CI): 0.72–0.88), as well as a lower risk of haemorrhagic stroke (subdistribution hazard ratio (SHR): 0.50; 95% CI: 0.38–0.67), heart failure (SHR: 0.771; 95% CI: 0.596–0.998), cardiovascular death (SHR: 0.64; 95% CI: 0.45–0.90), and all-cause mortality (HR: 0.72; 95% CI: 0.62–0.85). Risk reductions in the primary endpoint increased progressively with a higher number of ABC_stroke criteria obtained. No significant interaction was observed in the association according to age, sex, or stroke severity.

Conclusions: In this cohort of Asian patients with first-ever ischaemic stroke, optimal management according to the ABC_stroke pathway was associated with a reduction in the risk of adverse outcomes.