Faculty and Staff Publications

Language

English

Publication Date

8-1-2021

Journal

Annals of Clinical and Translational Neurology

DOI

10.1002/acn3.51400

PMID

34247448

PMCID

PMC8351388

PubMedCentral® Posted Date

7-11-2021

PubMedCentral® Full Text Version

Post-print

Abstract

Objective: The American Heart Association recently raised the bar on the timely treatment of acute ischemic stroke (AIS) with intravenous alteplase. Our study looks at the effectiveness of this new standard, by examining the effect of varying door-to-needle times of alteplase initiation on the clinical, quality of care, and efficiency of care outcomes.

Methods: This retrospective case-control study examined 752 AIS patients treated with intravenous alteplase in a large academic health system during 2015-2018, and compared their outcomes after treatment within 30, 45, and 60 min of arrival. The outcomes compared were: (1) clinical - discharge and 90-day modified Rankin Scale (mRS), and post-intravenous alteplase (24-h) NIH Stroke Scale (NIHSS); (2) quality of care - inpatient mortality, 30-day readmission, discharge to home, and disability at discharge; (3) efficiency of care - length of stay (LOS) and index stroke hospitalization costs. Adjusted logistic and linear regression analyses were used to estimate the effects, after controlling for baseline characteristics.

Results: Based on the adjusted regression analyses, treatment within 30 min of arrival was associated with better post-treatment mRS and NIHSS scores, and the clinical benefits were reduced when the windows were expanded to within 45 or 60 min. An important finding of the study was that treatment within 30 min of arrival significantly reduced the average LOS.

Interpretation: Early intravenous alteplase treatment significantly improved clinical and efficiency of care outcomes. This study provides evidence that meeting the new AHA Target Stroke recommendations will help hospitals improve patient clinical outcomes and reduce LOS, thereby improving the efficiency of care standards.

Keywords

Aged, Case-Control Studies, Female, Fibrinolytic Agents, Humans, Ischemic Stroke, Male, Middle Aged, Outcome and Process Assessment, Health Care, Retrospective Studies, Time Factors, Time-to-Treatment, Tissue Plasminogen Activator

Published Open-Access

yes

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