Abstract 3141: Elderly Ischemic Stroke Patients are Less Likely to be Treated with Rt-PA
Intro: Numerous reports have found that overall, rates of rt-PA treatment are low. Previously we have reported the rate of eligibility for rt-PA treatment to be approximately 8% of ischemic stroke patients,, but that eligibility actually significantly increases with age. However, we hypothesize that treatment with rt-PA in practice is actually utilized less among the elderly. We sought to describe treatment rates by decade within the Premier database.
Methods: This analysis utizlied the Premier database, a representative sampling of US hospitals that includes approx. 15% of hospital discharges, with access to pharmacy records Study period was FY 2009-2010. Cases potentially eligible for rt-PA treatment based on diagnosis were defined as those patient visits within DRGs 61-66 who did not have a transient ischemic attack (TIA) or hemorrhagic stroke discharge ICD-9 code (430, 431, 432, and 435). Cases receiving thrombolysis were identified by having an ICD-9 code of 99.10, which denotes thrombolytic use, OR who had pharmacy billing codes for thrombolytic therapy, limited to alteplase (activase), 50 mg and 100 mg vials. Rates of thrombolytic use were stratified by fiscal year.
Results: There were 101567 ischemic stroke cases included in this analysis, which were 16.2% black, 63.7% white, and 20.1% other, with a mean age of 71.2 (SD=15). During each study year, the overall rates of tpa treatment were 4.2% and 4.7% for 2009 and 2010. Rates of thrombolysis use stratified by age of the patient are presented in the Table. Overall there was a statistically significant decrease in treatment rates with increasing age (p<0.001) after adjustment for race and gender.
Discussion: Despite previously shown higher rates of eligibility, elderly patients are significantly less likely to be treated with rt-PA than younger aged patients. Whether this represents ageism by the healthcare system, or unmeasured/undocumented co-morbidities or exclusions requires further study.
- © 2012 by American Heart Association, Inc.