Abstract 191: Trends in Timely Arrival for Acute Ischemic Stroke Patients in the Paul Coverdell National Acute Stroke Registry 2005-2010
Background: Thrombolytic therapy (tPA) is administered infrequently due to the narrow therapeutic window limitation. This study assesses trends over time for hospital arrival, EMS use, and tPA use among acute ischemic stroke patients in the Paul Coverdell National Acute Stroke Registry (PCNASR), a quality improvement program for acute stroke implemented by state health departments.
Methods: There were 114,420 PCNASR patients enrolled from January 2005-December 2010 with a clinical diagnosis of acute ischemic stroke. Cochran-Armitage tests were used to test for a trend on selected demographic or clinical characteristics over time. Logistic regression analysis was used to assess factors associated receipt of tPA within 3 hours of time last known to be well (LKW) among patients who arrived by EMS or private auto.
Results: Among 114,420 acute ischemic stroke patients admitted between 2005 and 2010, documentation of LKW increased slightly (45.3% vs. 46.6%, p<0.001). Patients arriving within 2 hours of LKW decreased from 2005 to 2010 (40.0% vs. 35.2%, p<0.001). Overall, 39.1% patients with documented LKW arrived at the hospital more than 4.5 hours in 2005 as compared to 43.9% in 2010 (p<0.001). Use of EMS decreased slightly from 2005 to 2010 (49.9% vs. 49.1%, p<0.001). Overall use of any tPA (IV or IA) increased from 6.4% to 9.2% (p<0.001) within the PCNASR. Factors significantly associated with receipt of IV tPA were use of EMS (AOR 3.2, [2.8, 3.6]), minority status (AOR Black 1.22 [1.08-1.38], AOR other non-white 1.49 [1.19, 1.86]), age less than 65 (AOR 1.29, [1.12, 1.49]), and independent ambulation prior to stroke (AOR 2.12, [1.77, 2.55]).
Conclusion: Little or no improvement in knowing LKW, use of EMS, and sooner arrival for acute stroke demonstrates the continued need for public education on signs, symptoms, and actions to take for acute stroke. Use of EMS had the largest association with the use of IV tPA, yet use of EMS has not improved over 6 years. Despite no improvement in timely arrival, overall use of tPA has increased over 6 years, suggesting benefit from the extended tPA time window, increased use of IA tPA, and/or increased willingness to provide IV tPA.
- © 2012 by American Heart Association, Inc.