(Stroke. 2001;32:1832.)
© 2001 American Heart Association, Inc.
Original Contributions |
Treatment With Tissue Plasminogen Activator and Inpatient Mortality Rates for Patients With Ischemic Stroke Treated in Community Hospitals
From the Pharmaceutical Outcomes Research and Policy Program, School of Pharmacy (S.D.R., D.K.B.), Departments of Neurology (S.C.C.), Radiology (J.G.J.), Neurological Surgery (J.G.J.), and Health Services (J.G.J.), School of Medicine, and the Schools of Nursing and Medicine (K.M.), University of Washington, Seattle, Wash; and HBS International, Inc (K.M.), Bellevue, Wash.
Correspondence to Shelby D. Reed, PhD, Duke Clinical Research Institute, PO Box 17969, 2400 Pratt St, Durham, NC 27715. E-mail reed0034{at}mc.duke.edu
Background and Purpose—— Most analyses of intravenous tissue plasminogen activator (IV tPA) use for acute stroke in routine practice have been limited by sample size and generally restricted to patients treated in large academic medical facilities. In the present study, we sought to estimate among community hospitals the use of IV tPA and to identify factors associated with the use of IV tPA and inpatient mortality.
Methods—— We evaluated a retrospective cohort of 23 058 patients with ischemic stroke from 137 community hospitals.
Results—— Three hundred sixty-two (1.6%) patients were treated with IV tPA, and 9.9% of those patients died during the hospitalization period. In 35.0% of the hospitals, no patients were treated with IV tPA, whereas 14.6% of hospitals treated 
3.0% with IV tPA. After control for multiple factors, younger patients, more severely ill patients (OR 2.02, 95% CI 1.36 to 3.01), and patients treated in rural hospitals (OR 1.80, 95% CI 0.99 to 3.26) were more likely to receive IV tPA, whereas black patients were less likely (OR 0.54, 95% CI 0.31 to 0.95). There also was a trend showing that women were less likely to receive IV tPA (OR 0.84, 95% CI 0.69 to 1.03). Factors associated with an increased odds of inpatient mortality included receipt of IV tPA among men (OR 2.81, 95% CI 1.72 to 4.58) and increased age. Black patients were 27% less likely to die during hospitalization (95% CI 0.60 to 0.90).
Conclusions—— In this large, retrospective evaluation of community hospital practice, the use IV tPA and inpatient mortality rates among IV tPA–treated patients were consistent with those of other studies. The likelihood of receiving IV tPA varies by race, age, disease severity, and possibly gender. These factors may influence mortality rates.
Editorial Comment
Director, OSF Stroke Network, Clinical Assistant Professor, Neurology & Clinical Pharmacology, University of Illinois College of Medicine at Peoria, Chair, ASA Peoria Tri-County Operation Stroke, Peoria, Illinois
This article has been cited by other articles:
 |
|
 |
|
  M. Reeves, A. Bhatt, P. Jajou, M. Brown, and L. Lisabeth Sex Differences in the Use of Intravenous rt-PA Thrombolysis Treatment for Acute Ischemic Stroke: A Meta-Analysis Stroke, May 1, 2009; 40(5): 1743 - 1749. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. W. Gargano, S. Wehner, and M. J. Reeves Do Presenting Symptoms Explain Sex Differences in Emergency Department Delays Among Patients With Acute Stroke? Stroke, April 1, 2009; 40(4): 1114 - 1120. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. J. Reeves, G. C. Fonarow, X. Zhao, E. E. Smith, L. H. Schwamm, and on behalf of the GWTG-Stroke Steering Committee & Quality of Care in Women With Ischemic Stroke in the GWTG Program Stroke, April 1, 2009; 40(4): 1127 - 1133. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. M. Reid, D. Dai, G. J. Gubitz, M. K. Kapral, C. Christian, and S. J. Phillips Gender Differences in Stroke Examined in a 10-Year Cohort of Patients Admitted to a Canadian Teaching Hospital Stroke, April 1, 2008; 39(4): 1090 - 1095. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
B. M. Demaerschalk, B. J. Bobrow, and M. Paulsen Development of a Metropolitan Matrix of Primary Stroke Centers: The Phoenix Experience Stroke, April 1, 2008; 39(4): 1246 - 1253. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. W. Gargano, S. Wehner, and M. Reeves Sex Differences in Acute Stroke Care in a Statewide Stroke Registry Stroke, January 1, 2008; 39(1): 24 - 29. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 G. Saposnik, A. Baibergenova, M. O'Donnell, M. D. Hill, M. K. Kapral, V. Hachinski, and On behalf of the Stroke Outcome Research Canada (S Hospital volume and stroke outcome: Does it matter? Neurology, September 11, 2007; 69(11): 1142 - 1151. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. Arnold, L. Kappeler, K. Nedeltchev, C. Brekenfeld, U. Fischer, B. Keserue, L. Remonda, G. Schroth, and H. P. Mattle Recanalization and Outcome After Intra-Arterial Thrombolysis in Middle Cerebral Artery and Internal Carotid Artery Occlusion: Does Sex Matter? Stroke, April 1, 2007; 38(4): 1281 - 1285. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M.S.V. Elkind, S. Prabhakaran, J. Pittman, W. Koroshetz, M. Jacoby, K. C. Johnston, and for the GAIN Americas Investigators Sex as a predictor of outcomes in patients treated with thrombolysis for acute stroke Neurology, March 13, 2007; 68(11): 842 - 848. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
H. J. Audebert, C. Kukla, B. Vatankhah, B. Gotzler, J. Schenkel, S. Hofer, A. Furst, and R. L. Haberl Comparison of Tissue Plasminogen Activator Administration Management Between Telestroke Network Hospitals and Academic Stroke Centers: The Telemedical Pilot Project for Integrative Stroke Care in Bavaria/Germany Stroke, July 1, 2006; 37(7): 1822 - 1827. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. Dubinsky and S.-M. Lai Mortality of stroke patients treated with thrombolysis: Analysis of nationwide inpatient sample Neurology, June 13, 2006; 66(11): 1742 - 1744. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
E. Bandera, M. Botteri, C. Minelli, A. Sutton, K. R. Abrams, and N. Latronico Cerebral Blood Flow Threshold of Ischemic Penumbra and Infarct Core in Acute Ischemic Stroke: A Systematic Review Stroke, May 1, 2006; 37(5): 1334 - 1339. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. Stramba-Badiale, K. M. Fox, S. G. Priori, P. Collins, C. Daly, I. Graham, B. Jonsson, K. Schenck-Gustafsson, and M. Tendera Cardiovascular diseases in women: a statement from the policy conference of the European Society of Cardiology Eur. Heart J., April 2, 2006; 27(8): 994 - 1005. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
Y. Z. Deng, M. J. Reeves, B. S. Jacobs, G. L. Birbeck, R. U. Kothari, S. L. Hickenbottom, A. J. Mullard, S. Wehner, K. Maddox, A. Majid, et al. IV tissue plasminogen activator use in acute stroke: Experience from a statewide registry Neurology, February 14, 2006; 66(3): 306 - 312. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 T. Kurth, A. M. Walker, R. J. Glynn, K. A. Chan, J. M. Gaziano, K. Berger, and J. M. Robins Results of Multivariable Logistic Regression, Propensity Matching, Propensity Adjustment, and Propensity-based Weighting under Conditions of Nonuniform Effect Am. J. Epidemiol., February 1, 2006; 163(3): 262 - 270. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
B. T. Bateman, H. C. Schumacher, B. Boden-Albala, M. F. Berman, J.P. Mohr, R. L. Sacco, and J. Pile-Spellman Factors Associated With In-Hospital Mortality After Administration of Thrombolysis in Acute Ischemic Stroke Patients: An Analysis of the Nationwide Inpatient Sample 1999 to 2002 Stroke, February 1, 2006; 37(2): 440 - 446. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. Bright and D. Mochly-Rosen The Role of Protein Kinase C in Cerebral Ischemic and Reperfusion Injury Stroke, December 1, 2005; 36(12): 2781 - 2790. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
G. Saposnik, S. Di Legge, F. Webster, and V. Hachinski Predictors of major neurologic improvement after thrombolysis in acute stroke Neurology, October 25, 2005; 65(8): 1169 - 1174. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. W. Wojner-Alexandrov, A. V. Alexandrov, D. Rodriguez, D. Persse, and J. C. Grotta Houston Paramedic and Emergency Stroke Treatment and Outcomes Study (HoPSTO) Stroke, July 1, 2005; 36(7): 1512 - 1518. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 N U Weir and A M Buchan A study of the workload and effectiveness of a comprehensive acute stroke service J. Neurol. Neurosurg. Psychiatry, June 1, 2005; 76(6): 863 - 865. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
The Paul Coverdell Prototype Registries Writing Gr Acute Stroke Care in the US: Results from 4 Pilot Prototypes of the Paul Coverdell National Acute Stroke Registry Stroke, June 1, 2005; 36(6): 1232 - 1240. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. D. Hill, A. M. Buchan, and for The Canadian Alteplase for Stroke Effectivenes Thrombolysis for acute ischemic stroke: results of the Canadian Alteplase for Stroke Effectiveness Study Can. Med. Assoc. J., May 10, 2005; 172(10): 1307 - 1312. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
Task Force Members, L. H. Schwamm, A. Pancioli, J. E. Acker III, L. B. Goldstein, R. D. Zorowitz, T. J. Shephard, P. Moyer, M. Gorman, S. C. Johnston, et al. Recommendations for the Establishment of Stroke Systems of Care: Recommendations From the American Stroke Association's Task Force on the Development of Stroke Systems Stroke, March 1, 2005; 36(3): 690 - 703. [Full Text] [PDF]
|
|
|
|
 |
|
 L. H. Schwamm, A. Pancioli, J. E. Acker III, L. B. Goldstein, R. D. Zorowitz, T. J. Shephard, P. Moyer, M. Gorman, S. C. Johnston, P. W. Duncan, et al. Recommendations for the Establishment of Stroke Systems of Care: Recommendations From the American Stroke Association's Task Force on the Development of Stroke Systems Circulation, March 1, 2005; 111(8): 1078 - 1091. [Full Text] [PDF]
|
|
|
|
|
|
California Acute Stroke Pilot Registry (CASPR) Inv Prioritizing interventions to improve rates of thrombolysis for ischemic stroke Neurology, February 22, 2005; 64(4): 654 - 659. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
V. C. Douglas, D. C. Tong, L. A. Gillum, S. Zhao, L. M. Brass, J. Dostal, and S. C. Johnston Do the Brain Attack Coalition's criteria for stroke centers improve care for ischemic stroke? Neurology, February 8, 2005; 64(3): 422 - 427. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. P. Stansbury, H. Jia, L. S. Williams, W. B. Vogel, and P. W. Duncan Ethnic Disparities in Stroke: Epidemiology, Acute Care, and Postacute Outcomes Stroke, February 1, 2005; 36(2): 374 - 386. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. U Farooq, D. Zemke, and A. Majid Minocycline has no effect on the fibrinolytic activity of alteplase Ann. Pharmacother., February 1, 2005; 39(2): 387 - 388. [Full Text] [PDF]
|
|
|
|
|
|
D. M. Kent, L. L. Price, P. Ringleb, M. D. Hill, and H. P. Selker Sex-Based Differences in Response to Recombinant Tissue Plasminogen Activator in Acute Ischemic Stroke: A Pooled Analysis of Randomized Clinical Trials Stroke, January 1, 2005; 36(1): 62 - 65. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. L. Brown, L. D. Lisabeth, N. M. Garcia, M. A. Smith, and L. B. Morgenstern Emergency department evaluation of ischemic stroke and TIA: The BASIC Project Neurology, December 28, 2004; 63(12): 2250 - 2254. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 P. U. Heuschmann, P. L. Kolominsky-Rabas, J. Roether, B. Misselwitz, K. Lowitzsch, J. Heidrich, P. Hermanek, C. Leffmann, M. Sitzer, M. Biegler, et al. Predictors of In-Hospital Mortality in Patients With Acute Ischemic Stroke Treated With Thrombolytic Therapy JAMA, October 20, 2004; 292(15): 1831 - 1838. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
T. J. Ingall, W. M. O'Fallon, K. Asplund, L. R. Goldfrank, V. S. Hertzberg, T. A. Louis, and T. J. H. Christianson Findings From the Reanalysis of the NINDS Tissue Plasminogen Activator for Acute Ischemic Stroke Treatment Trial Stroke, October 1, 2004; 35(10): 2418 - 2424. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 P. U. Heuschmann, P. L. Kolominsky-Rabas, B. Misselwitz, P. Hermanek, C. Leffmann, R. W. C. Janzen, J. Rother, H.-J. Buecker-Nott, K. Berger, and for The German Stroke Registers Study Group Predictors of In-Hospital Mortality and Attributable Risks of Death After Ischemic Stroke: The German Stroke Registers Study Group Arch Intern Med, September 13, 2004; 164(16): 1761 - 1768. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. C. Cramer, G. Rordorf, J. H. Maki, L. A. Kramer, J. C. Grotta, W. S. Burgin, J. A. Hinchey, C. Benesch, K. L. Furie, H. L. Lutsep, et al. Increased Pelvic Vein Thrombi in Cryptogenic Stroke: Results of the Paradoxical Emboli From Large Veins in Ischemic Stroke (PELVIS) Study Stroke, January 1, 2004; 35(1): 46 - 50. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. U. Lattimore, J. Chalela, L. Davis, T. DeGraba, M. Ezzeddine, J. Haymore, P. Nyquist, A. E. Baird, J. Hallenbeck, and S. Warach Impact of Establishing a Primary Stroke Center at a Community Hospital on the Use of Thrombolytic Therapy: The NINDS Suburban Hospital Stroke Center Experience Stroke, June 1, 2003; 34 (6): e55 - e57. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J.M. Wardlaw, P.A.G. Sandercock, and E. Berge Thrombolytic Therapy With Recombinant Tissue Plasminogen Activator for Acute Ischemic Stroke: Where Do We Go From Here? A Cumulative Meta-Analysis Stroke, June 1, 2003; 34(6): 1437 - 1442. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. U. Heuschmann, K. Berger, B. Misselwitz, P. Hermanek, C. Leffmann, M. Adelmann, H.-J. Buecker-Nott, J. Rother, B. Neundoerfer, and P. L. Kolominsky-Rabas Frequency of Thrombolytic Therapy in Patients With Acute Ischemic Stroke and the Risk of In-Hospital Mortality: The German Stroke Registers Study Group Stroke, May 1, 2003; 34(5): 1106 - 1112. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
N. Nighoghossian Editorial Comment--tPA in Daily Clinical Practice Stroke, May 1, 2003; 34(5): 1112 - 1113. [Full Text] [PDF]
|
|
|
|
 |
|
 C. Warlow and J. Wardlaw Therapeutic thrombolysis for acute ischaemic stroke BMJ, February 1, 2003; 326(7383): 233 - 234. [Full Text] [PDF]
|
|
|
|
|
|
D. M. Bravata, N. Kim, J. Concato, H. M. Krumholz, and L. M. Brass Thrombolysis for Acute Stroke in Routine Clinical Practice Arch Intern Med, September 23, 2002; 162(17): 1994 - 2001. [Abstract] [Full Text] [PDF]
|
|