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Use of Strategies to Improve Door-to-Needle Times with Tissue Plasminogen Activator in Acute Ischemic Stroke by US Hospitals: Findings from the Target: Stroke Survey

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  1. Use of Strategies to Improve Door-to-Needle Times with Tissue Plasminogen Activator in Acute Ischemic Stroke by US Hospitals: Findings from the Target: Stroke Survey Gregg C. Fonarow1; Eric E. Smith2; Xin Zhao3; Eric D. Peterson3; Ying Xian3; DaiWai M. Olson3,4; Adrian F. Hernandez3; Deepak L. Bhatt5; Jeffrey L. Saver6; Lee H. Schwamm7 1Division of Cardiology, University of California, Los Angeles, CA; 2Department of Clinical Neurosciences, Hotchkiss Brain Institute, University of Calgary, Alberta, Canada; 3Duke Clinical Research Institute, Durham, NC;4University of Texas Southwestern Medical Center, Dalls, TX; 5VA Boston Healthcare System, Boston, MA; 6Department of Neurology, University of California, Los Angeles, CA; 7Department of Neurology, Massachusetts General Hospital, Boston, MA Background Results Hospital Characteristics • The benefits of intravenous tissue-plasminogen activator (IV tPA) in acute ischemic stroke are time-dependent • National guidelines recommend door-to-needle time ≤60 minutes. However, fewer than 1/3 of patients treated with IV tPA are treated within guideline recommended door-to-needle time • Several strategies have been reported to be associated with more rapid door-to-needle (DTN) times. However, the extent to which hospitals are utilizing these strategies has not been well studied. Strategies Reported by Hospitals to Improve Acute Ischemic Stroke Evaluation and Treatment Times Methods Distribution of Door-to-Needle Times among 5,460 Patients from 304 Hospitals in Target: Stroke • Target: Stroke is a national initiative sponsored by the AHA/ASA to assist hospitals in increasing the proportion of IV tPA-treated patients who achieve guideline-recommended door-to-needle within 60 mins • We surveyed 350 hospitals joining Target: Stroke regarding their baseline use of strategies to reduce door-to-needle time prior to the initiation of Target Stroke • The survey was developed based on literature review and expert consensus for strategies identified as being associated with shorter door-to-needle times • After excluding 46 hospitals that did not give tPA or reported invalid treatment timelines, the final study population consisted of 5,460 patients from 304 hospitals between 1/2008-2/2010 Conclusions • While most US hospitals participating in this survey report use of the strategies to improve the timeliness of tPA administration for acute ischemic stroke, significant variation exists • Further research is needed to understand which of these strategies are most effective in improving acute ischemic stroke care DISCLOSURE INFORMATION: Target: Stroke is an initiative provided by the American Heart Association/American Stroke Association. The University of California, Regents receive funding for Dr Saver’s services as a scientific consultant regarding trial design and conduct to Covidien, CoAxia, BrainsGate, Genervon, and Grifols. Dr Saver is an investigator in the NIH FAST-MAG, MR RESCUE, CLEARER, and IMS 3 multicenter clinical trials for which the UC Regents receive payments on the basis of clinical trial performance; has served as an unpaid site investigator in multicenter trials run by Lundbeck and Covidien for which the UC Regents received payments on the basis of clinical trial contracts for the number of subjects enrolled; and is an employee of the University of California, which holds patent rights in coil retrievers. Dr. Deepak L. Bhatt discloses the following relationships - Advisory Board: Medscape Cardiology; Board of Directors: Boston VA Research Institute, Society of Chest Pain Centers; Chair: American Heart Association Get With The Guidelines Science Subcommittee; Honoraria: American College of Cardiology (Editor, Clinical Trials, Cardiosource), Duke Clinical Research Institute (clinical trial steering committees), Slack Publications (Chief Medical Editor, Cardiology Today Intervention), WebMD (CME steering committees); Other: Senior Associate Editor, Journal of Invasive Cardiology; Research Grants: Amarin, AstraZeneca, Bristol-Myers Squibb, Eisai, Ethicon, Medtronic, Sanofi Aventis, The Medicines Company; Unfunded Research: FlowCo, PLxPharma, Takeda.

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