BACKGROUND: Thrombolytic treatment has been shown to be effective in the treatment of ischemic stroke when initiated within 3 hours of symptom onset, yet few patients receive thrombolytics. OBJECTIVE: To estimate expected increases in use of thrombolytics for ischemic stroke given the following interventions: educating patients to present earlier, optimizing Emergency Medical Services (EMS) response/transport times, optimizing hospital systems, and extending the treatment window. METHODS: As part of a Centers for Disease Control-sponsored Coverdell Acute Stroke Pilot Registry, the authors prospectively identified all patients with an initial diagnosis of ischemic stroke at 11 hospitals in California over a 3-month period. Timing of symptom onset, EMS response, hospital arrival, treatment, and reasons for nontreatment were evaluated, and hypothetical treatment rates for thrombolysis for interventions on the stroke-care continuum were derived based on observed rates of eligibility and treatment. RESULTS: Of 374 patients with ischemic stroke, 88 (23.5%) arrived at the emergency department within 3 hours of symptom onset, of whom 16 (4.3%) received thrombolysis. If all patients with known onset times had called 911 immediately, the expected overall rate of thrombolytic treatment within 3 hours would have increased from 4.3 to 28.6%. Expected rates of thrombolysis were lower for other interventions: instantaneous prehospital response 5.5%, perfect hospital care 11.5%, and extension of time window to 6 hours 8.3%. If all patients with known onset had arrived within 1 hour and been optimally treated, 57% could have been treated. CONCLUSION: Campaigns that educate patients to seek treatment sooner should be major components of system-wide interventions to increase rates of thrombolysis for acute ischemic stroke.
BACKGROUND: Thrombolytic treatment has been shown to be effective in the treatment of ischemic stroke when initiated within 3 hours of symptom onset, yet few patients receive thrombolytics. OBJECTIVE: To estimate expected increases in use of thrombolytics for ischemic stroke given the following interventions: educating patients to present earlier, optimizing Emergency Medical Services (EMS) response/transport times, optimizing hospital systems, and extending the treatment window. METHODS: As part of a Centers for Disease Control-sponsored Coverdell Acute Stroke Pilot Registry, the authors prospectively identified all patients with an initial diagnosis of ischemic stroke at 11 hospitals in California over a 3-month period. Timing of symptom onset, EMS response, hospital arrival, treatment, and reasons for nontreatment were evaluated, and hypothetical treatment rates for thrombolysis for interventions on the stroke-care continuum were derived based on observed rates of eligibility and treatment. RESULTS: Of 374 patients with ischemic stroke, 88 (23.5%) arrived at the emergency department within 3 hours of symptom onset, of whom 16 (4.3%) received thrombolysis. If all patients with known onset times had called 911 immediately, the expected overall rate of thrombolytic treatment within 3 hours would have increased from 4.3 to 28.6%. Expected rates of thrombolysis were lower for other interventions: instantaneous prehospital response 5.5%, perfect hospital care 11.5%, and extension of time window to 6 hours 8.3%. If all patients with known onset had arrived within 1 hour and been optimally treated, 57% could have been treated. CONCLUSION: Campaigns that educate patients to seek treatment sooner should be major components of system-wide interventions to increase rates of thrombolysis for acute ischemic stroke.
Authors: Véronique L Roger; Alan S Go; Donald M Lloyd-Jones; Emelia J Benjamin; Jarett D Berry; William B Borden; Dawn M Bravata; Shifan Dai; Earl S Ford; Caroline S Fox; Heather J Fullerton; Cathleen Gillespie; Susan M Hailpern; John A Heit; Virginia J Howard; Brett M Kissela; Steven J Kittner; Daniel T Lackland; Judith H Lichtman; Lynda D Lisabeth; Diane M Makuc; Gregory M Marcus; Ariane Marelli; David B Matchar; Claudia S Moy; Dariush Mozaffarian; Michael E Mussolino; Graham Nichol; Nina P Paynter; Elsayed Z Soliman; Paul D Sorlie; Nona Sotoodehnia; Tanya N Turan; Salim S Virani; Nathan D Wong; Daniel Woo; Melanie B Turner Journal: Circulation Date: 2011-12-15 Impact factor: 29.690
Authors: Véronique L Roger; Alan S Go; Donald M Lloyd-Jones; Robert J Adams; Jarett D Berry; Todd M Brown; Mercedes R Carnethon; Shifan Dai; Giovanni de Simone; Earl S Ford; Caroline S Fox; Heather J Fullerton; Cathleen Gillespie; Kurt J Greenlund; Susan M Hailpern; John A Heit; P Michael Ho; Virginia J Howard; Brett M Kissela; Steven J Kittner; Daniel T Lackland; Judith H Lichtman; Lynda D Lisabeth; Diane M Makuc; Gregory M Marcus; Ariane Marelli; David B Matchar; Mary M McDermott; James B Meigs; Claudia S Moy; Dariush Mozaffarian; Michael E Mussolino; Graham Nichol; Nina P Paynter; Wayne D Rosamond; Paul D Sorlie; Randall S Stafford; Tanya N Turan; Melanie B Turner; Nathan D Wong; Judith Wylie-Rosett Journal: Circulation Date: 2010-12-15 Impact factor: 29.690
Authors: Thomas M Hemmen; Rema Raman; Kama Z Guluma; Brett C Meyer; Joao A Gomes; Salvador Cruz-Flores; Christine A Wijman; Karen S Rapp; James C Grotta; Patrick D Lyden Journal: Stroke Date: 2010-08-19 Impact factor: 7.914
Authors: Natalia S Rost; Eric E Smith; Muhammad A Pervez; Philip Mello; Paul Dreyer; Lee H Schwamm Journal: Circ Cardiovasc Qual Outcomes Date: 2012-04-24
Authors: Gregory M Lanza; Jon N Marsh; Grace Hu; Michael J Scott; Anne H Schmieder; Shelton D Caruthers; Dipanjan Pan; Samuel A Wickline Journal: Stroke Date: 2010-10 Impact factor: 7.914