Quality program linked with faster stroke treatment and better outcomes

American Stroke Association Meeting Late-Breaking Science Report Abstract: LB12 (Hall E)

February 14, 2014 Categories: Scientific Conferences & Meetings, Stroke News

Study Highlights:

  • Patients received stroke therapy significantly faster in hospitals that used The American Heart Association/American Stroke Association’s quality improvement initiative -- Target: Stroke.
  • Between 2010 and 2013, the time between hospital arrival and use of clot-busters dropped by 15 minutes in hospitals that follow the Target: Stroke guidelines.
  • Faster treatment was associated with improved patient outcomes and fewer complications, including death.
Embargoed until Noon PT/ 3 p.m. ET Friday, February 14, 2014
This news release (which contains updated data from the abstract) is featured in an embargoed news briefing at 8 a.m. PT Fri., Feb. 14.

SAN DIEGO, Feb. 14, 2014 – A national quality improvement initiative focusing on quicker stroke treatment was associated with better stroke treatment and outcomes, according to a late-breaking science report presented at the American Stroke Association’s International Stroke Conference 2014.

      The study examined data from hospitals that have adopted the American Heart Association/ American Stroke Association’s national quality initiative, Target: Stroke, which aims to increase the number of stroke patients treated with clot-busting drugs for ischemic stroke within 60 minutes or less after hospital arrival.

The only treatment approved by the U.S. Food and Drug Administration for stroke is tPA, or tissue plasminogen activator, a drug injected intravenously to dissolve blood clots. As the benefit of tPA is highly time dependent, national guidelines recommend tPA treatment within 60 minutes or less of hospital arrival. Initiated nationwide in 2010, Target: Stroke provided 10 key strategies as well as tools to facilitate timely tPA administration, as well as additional approaches to improve stroke care and outcome.

This study found that the percentage of patients treated within the recommended timeframe increased from less than one-third before Target: Stroke to more than half afterwards. The Target: Stroke program goal of 50 percent or more of patients having door-to-needle times within 60 minutes was successfully achieved. In addition, the average time to treatment dropped by 15 minutes, from 74 to 59 minutes.

Faster treatment was associated with lower rates of complications, including death. Before Target: Stroke, 9.9 percent of stroke patients died in the hospital, compared to 8.3 percent of patients treated after the initiative started, a difference which was statistically significant. In addition, patients treated by Target: Stroke strategies were less likely to develop the complication of bleeding within the skull.

“These findings further reinforce the importance and clinical benefits of faster administration of intravenous tPA,” said Gregg C. Fonarow, M.D., the Eliot Corday Professor of Cardiovascular Medicine and Science, and director of the Ahmanson-UCLA Cardiomyopathy Center at the David Geffen School of Medicine at the University of California, Los Angeles. “By showing that the timeliness of tPA administration can be improved at the national level, these findings also support further expansion of the Target: Stroke initiative.”

Investigators analyzed data from 71,169 tPA-treated stroke patients at 1,029 hospitals participating in Target: Stroke. They compared the time to treatment and incidence of complications before implementation, from 2003 to 2009, to the post-implementation years, from 2010 to 2013.

Patients’ average age was 72 years, and 50 percent were female. Almost three-quarters of patients were white, 14 percent were black and 6 percent were Hispanic. Follow-up was three years.

Importantly, the significant improvement in treatment times was seen in both older and younger patients, and men and women; and was also seen in white, black and Hispanic patients,” said Fonarow, a member of the AHA/ASA Target: Stroke Committee. “Reducing gender and racial disparity gaps in care and making sure all patients get the treatment they need is an important focus of Target: Stroke and all our quality improvement programs.”

Each year in the United States, stroke affects nearly 800,000 people. It’s the fourth-leading cause of death and a leading cause of disability among U.S. adults. Survival depends upon prompt treatment to restore blood flow to the brain.

Most strokes can be prevented by modifying risk factors, including controlling high blood pressure, cholesterol, diabetes and obesity; avoiding cigarette smoking; following a healthy diet; and being physically active.

Co-authors are Xin Zhao, M.S.; Eric E. Smith, M.D., M.P.H.; Jeffrey L. Saver, M.D.; Mathew J. Reeves, Ph.D.; Deepak L. Bhatt, M.D., M.P.H.; Ying Xian, M.D., Ph.D.; Adrian F. Hernandez, M.D., M.H.S.; Eric D. Peterson, M.D., M.P.H.; and Lee H. Schwamm, M.D.

Author disclosures are on the abstract.

The study was funded by the American Heart Association/American Stroke Association.

Statements and conclusions of study authors that are presented at American Stroke Association scientific meetings are solely those of the study authors and do not necessarily reflect association policy or position.  The association makes no representation or warranty as to their accuracy or reliability. The association receives funding primarily from individuals; foundations and corporations (including pharmaceutical, device manufacturers and other companies) also make donations and fund specific association programs and events.  The association has strict policies to prevent these relationships from influencing the science content.  Revenues from pharmaceutical and device corporations are available at www.heart.org/corporatefunding.

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Note: Actual presentation is 12:47 p.m., Friday, February 14, 2014 in Hall E.

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