Target: Stroke program demonstrates substantially improved outcomes in adherence to stroke care guidelines; phase III kicks off

American Stroke Association Meeting Report: POSTER SESSION I - Poster Board Number LBP9 / Presentation Number LBP9

February 06, 2019 Categories: Stroke News, Scientific Conferences & Meetings

Highlights:

  • There was substantial further improvement in time to alteplase administration in GWTG-Stroke hospitals after implementation of Target: Stroke Phase II achieving door-to-needle times within 60 minutes for 75 percent or more of acute ischemic stroke patients.
  • Target: Stroke Phase II was associated with improvements in clinical outcomes for patients with acute ischemic stroke.
  • Target: Stroke Phase III launches with national goal to achieve door-to-needle times within 60 minutes for 85 percent or more patients and achieve to door-to-device times within 90 minutes for direct arriving patients and within 60 minutes for transfer patients in 50 percent or more patients treated with endovascular therapy.

HONOLULU, February 6, 2019 — Hospitals implementing the American Heart Association/American Stroke Association Target: Stroke Phase II strategies decreased the median door-to-needle time from 66 minutes to 51 minutes, according to a study presented today presented in Honolulu at the American Stroke Association’s International Stroke Conference 2019, a world premier meeting for researchers and clinicians dedicated to the science and treatment of cerebrovascular disease.

The study, “Achieving More Rapid Door-to-Needle Times in Acute Ischemic Stroke,” found there were substantial improvements in time to alteplase administration in Get with the Guidelines-Stroke® hospitals after implementation of Target: Stroke Phase II and the program’s national goals were achieved with clinical outcomes also being significantly improved.

Target: Stroke is a national quality improvement initiative focused on improving acute ischemic stroke care and outcomes by reducing door-to-needle (DTN) times for eligible patients treated with intravenous alteplase. The primary national goal of Target: Stroke Phase II was for hospitals to achieve door-to-needle times within 60 minutes for 75 percent or more of acute ischemic stroke patients treated with intravenous alteplase, with a secondary goal of 45 minutes or less DTN in 50 percent or more of the same category of patients. 

The researchers found when comparing all patients treated in Phase I with Phase II, the median DTN time decreased from 66 minutes to 51 minutes and the percentage of patients with DTN times less than or equal to 60 minutes increased from 42 percent to 67 percent. 

“It is a common saying in the stroke community – ‘time is brain’ - but it is entirely true,” said Gregg C. Fonarow M.D. Director of the Ahmanson-UCLA Cardiomyopathy Center, co-chief of UCLA's Division of Cardiology and Professor of Cardiovascular Medicine, UCLA, Los Angeles California, lead author of the study and volunteer expert for the American Heart Association.  “Every minute a stroke goes untreated a typical patient loses 1.9 million neurons – so a faster response time is critical to improved patient outcomes.”

Introducing Target: Stroke Phase III

Alongside the research surrounding the program’s recent success in Phase II, the American Heart Association/American Stroke Association is announcing Phase III of its Target: Stroke program.

“Phase III of this American Heart Association/American Stroke Association initiative further raises the bar by setting more aggressive targets for timely treatment with IV alteplase, “said Fonarow. “But now the aim goes beyond faster door-to-needle times. Phase III introduces a second type of intervention into the mix, setting the first-ever targets for prompt treatment with endovascular therapy.”

Target: Stroke Phase III aims to continue to improve on DTN times, as well as introduce goals for door-to-device times for endovascular therapy devices. The primary goals of Phase III are achieving DTN times within 60 minutes for 85 percent or more of acute ischemic stroke patients treated with IV thrombolytics – with secondary goals of getting down to 45- and 30-minute timelines as well. 

“We see these goals as aggressive – but also completely attainable – and more importantly we believe that it will continue to improve outcomes and save the lives of additional acute ischemic stroke patients.  At the end of the day – that is everyone’s goal,” added Fonarow. 

The Target: Stroke program helps hospitals identify best practice strategies, utilize clinical decision tools, and guidelines for patient care. Research analyzing data from this program supports the conclusion that quality improvement measures from Target: Stroke result in substantial improvement in patient care and outcomes.  

There are more than 1,200 Target: Stroke hospitals across the United States.

Poster Board Number LBP9 / Presentation Number LBP9 - Achieving More Rapid Door-to-Needle Times in Acute Ischemic Stroke: Results of Target: Stroke Phase II

Authors: Gregg C. Fonarow, UCLA Medical Ctr, Los Angeles, CA; Shubin Sheng, DCRI, Durham, NC; Eric E. Smith, Univ of Calgary, Calgary, AB, Canada; Jeffrey Saver, UCLA Medical Ctr, Los Angeles, CA; Mathew Reeves, Michigan State Univ, East Lansing, MI; Deepak Bhatt, Brigham and Women's Hosp, Boston, MA; Ying Xian, Adrian Hernandez, Eric Peterson, DCRI, Durham, NC; Lee Schwamm, Harvard Medical Sch, Boston, MA

Note: Scientific presentations take place at 6:30 PM HST/11:30 PM- EST Wednesday, Feb. 6, 2019.

Author disclosures are noted on the abstracts.

Additional Resources:

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 https://www.heart.org/en/about-us/aha-financial-information.

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About the American Stroke Association

The American Stroke Association is devoted to saving people from stroke — the No. 2 cause of death in the world and a leading cause of serious disability. We team with millions of volunteers to fund innovative research, fight for stronger public health policies and provide lifesaving tools and information to prevent and treat stroke. The Dallas-based association officially launched in 1998 as a division of the American Heart Association. To learn more or to get involved, call 1-888-4STROKE or visit StrokeAssociation.org. Follow us on Facebook and Twitter.

For Media Inquiries and ASA Expert Perspective: 214-706-1173

Karen Springs: 214-706-4831; karen.springs@heart.org

For Public Inquiries: 1-800-AHA-USA1 (242-8721)

Feb. 6-8, 2019: AHA News Media Office at the Honolulu Convention Center: 808-792-6530

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