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Target: Stroke Was Associated With Faster Intravenous Thrombolysis and Improved One-Year Outcomes for Acute Ischemic Stroke in Medicare Beneficiaries.

Publication ,  Journal Article
Man, S; Xian, Y; Holmes, DN; Matsouaka, RA; Saver, JL; Smith, EE; Bhatt, DL; Schwamm, LH; Fonarow, GC
Published in: Circ Cardiovasc Qual Outcomes
December 2020

BACKGROUND: The benefit of intravenous thrombolytic therapy for acute ischemic stroke is time dependent. To assist hospitals in providing faster thrombolytic treatment, the American Heart Association launched target: stroke quality initiative in January 2010 which disseminated feasible strategies to shorten door-to-needle times for thrombolytic therapy. This study aimed to examine whether target: stroke was associated with improved door-to-needle times and 1-year outcomes. METHODS: We analyzed Medicare beneficiaries aged ≥65 years receiving intravenous thrombolytic treatment for acute ischemic stroke at 1490 Get With The Guidelines-Stroke hospitals during January 2006 and December 2009 (preintervention, n=10 804) and January 2010 and December 2014 (postintervention, n=31 249). The median age was 80 years and 42.7% were male. RESULTS: The median door-to-needle times decreased from 80 minutes for the preintervention to 68 minutes for the postintervention (P<0.001). The proportion of patients receiving intravenous thrombolysis with door-to-needle times 45 minutes and 60 minutes increased from 9.6% and 24.8% for preintervention to 17.1% and 40.6% for postintervention, respectively (P<0.001). The annual rate of increase in the door-to-needle times of 60 minutes or less accelerated from 0.20% (95% CI, -0.43% to 0.83%) per each 4 quarters for preintervention to 5.68% (95% CI, 5.23%-6.13%) for postintervention (P<0.001) which was further confirmed in piecewise multivariable generalized estimating analysis (adjusted odds ratio, 1.27 [95% CI, 1.19-1.35]). Cox proportional hazards analysis, after adjusting for patient and hospital characteristics and within-hospital clustering, showed that target: stroke was associated with lower all-cause readmission (40.4% versus 44.1%; hazard ratio, 0.91 [95% CI, 0.88-0.95]), cardiovascular readmission (19.7% versus 22.9%; hazard ratio, 0.85 [95% CI, 0.80-0.89]), and composite of all-cause mortality or readmission (56.0% versus 58.4%; hazard ratio, 0.96 [95% CI, 0.93-1.00]). The risk decline in all-cause mortality dissipated after risk adjustment (adjusted hazard ratio, 0.98 [95% CI, 0.94-1.02]). CONCLUSIONS: Target: stroke quality initiative was associated with faster thrombolytic treatment times for acute ischemic stroke and modestly lower 1-year all-cause and cardiovascular readmissions.

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Published In

Circ Cardiovasc Qual Outcomes

DOI

EISSN

1941-7705

Publication Date

December 2020

Volume

13

Issue

12

Start / End Page

e007150

Location

United States

Related Subject Headings

  • United States
  • Treatment Outcome
  • Time-to-Treatment
  • Time Factors
  • Thrombolytic Therapy
  • Risk Factors
  • Risk Assessment
  • Retrospective Studies
  • Quality Indicators, Health Care
  • Quality Improvement
 

Citation

APA
Chicago
ICMJE
MLA
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Man, S., Xian, Y., Holmes, D. N., Matsouaka, R. A., Saver, J. L., Smith, E. E., … Fonarow, G. C. (2020). Target: Stroke Was Associated With Faster Intravenous Thrombolysis and Improved One-Year Outcomes for Acute Ischemic Stroke in Medicare Beneficiaries. Circ Cardiovasc Qual Outcomes, 13(12), e007150. https://doi.org/10.1161/CIRCOUTCOMES.120.007150
Man, Shumei, Ying Xian, DaJuanicia N. Holmes, Roland A. Matsouaka, Jeffrey L. Saver, Eric E. Smith, Deepak L. Bhatt, Lee H. Schwamm, and Gregg C. Fonarow. “Target: Stroke Was Associated With Faster Intravenous Thrombolysis and Improved One-Year Outcomes for Acute Ischemic Stroke in Medicare Beneficiaries.Circ Cardiovasc Qual Outcomes 13, no. 12 (December 2020): e007150. https://doi.org/10.1161/CIRCOUTCOMES.120.007150.
Man S, Xian Y, Holmes DN, Matsouaka RA, Saver JL, Smith EE, et al. Target: Stroke Was Associated With Faster Intravenous Thrombolysis and Improved One-Year Outcomes for Acute Ischemic Stroke in Medicare Beneficiaries. Circ Cardiovasc Qual Outcomes. 2020 Dec;13(12):e007150.
Man, Shumei, et al. “Target: Stroke Was Associated With Faster Intravenous Thrombolysis and Improved One-Year Outcomes for Acute Ischemic Stroke in Medicare Beneficiaries.Circ Cardiovasc Qual Outcomes, vol. 13, no. 12, Dec. 2020, p. e007150. Pubmed, doi:10.1161/CIRCOUTCOMES.120.007150.
Man S, Xian Y, Holmes DN, Matsouaka RA, Saver JL, Smith EE, Bhatt DL, Schwamm LH, Fonarow GC. Target: Stroke Was Associated With Faster Intravenous Thrombolysis and Improved One-Year Outcomes for Acute Ischemic Stroke in Medicare Beneficiaries. Circ Cardiovasc Qual Outcomes. 2020 Dec;13(12):e007150.

Published In

Circ Cardiovasc Qual Outcomes

DOI

EISSN

1941-7705

Publication Date

December 2020

Volume

13

Issue

12

Start / End Page

e007150

Location

United States

Related Subject Headings

  • United States
  • Treatment Outcome
  • Time-to-Treatment
  • Time Factors
  • Thrombolytic Therapy
  • Risk Factors
  • Risk Assessment
  • Retrospective Studies
  • Quality Indicators, Health Care
  • Quality Improvement