Abstract 3338: Marked Increase in Proportion of Patients over 80 years Treated with iv Thrombolysis and Registered in SITS (Safe Implementation of Treatments in Stroke) Coincides with Publications
Objectives. A prompt increase in patients treated in the extended time window 3-4.5 h after stroke onset was noted in the SITS registry after publication of the results of ECASS III (NEJM 2008) and the SITS-ISTR 3-4.5 h cohort (Lancet 2008). Within a few months the proportion increased from around 7% to a plateau of 20%. In November 2010, three studies were published describing SITS and VISTA (Virtual International Stroke Trials Archive) data on safety and efficacy of i.v. thrombolysis in the elderly population (Mishra et al, Stroke 2010, Ford et al, Stroke 2010; Mishra et al, BMJ 2010). We tested for a similarly rapid response to the publications of results in the elderly .
Methods: Between 1st January 2007 and 30th June 2011, 36,753 patients treated with i.v. thrombolysis were registered in SITS, of whom 4,458 were over 80 years (12.1%). We examined the quarterly rates and 95% confidence intervals of patients over age 80 treated with i.v. thrombolysis. Since all 3 studies were published around November 2010, we compared the rates in the intervals Q1 2007-Q3 2010 and Q4 2010- Q2 2011.
Results: The proportion of elderly (over 80 years) was 11.1 % (95% CI 10.8-11.5) across Q1 2007 to Q3 2010, From Q4 2010 to Q2 2011 it increased to 17.5 %, (95% CI 16.5-18.5, (p<0.0001). The proportions during 2010 Q1-Q3 were 10.6%, 11.9%, 11.3% (pre-publication) and during 2010 Q4 to 2011Q216.9%, 16.4% and 19.3% (post-publication).
Conclusions: A statistically significant increase in the proportion of elderly treated with i.v. thrombolysis was observed from the fourth quarter of 2010. The relative increase approached 60% and coincided with three publications of safety and efficacy of i.v. thrombolysis in the elderly based on VISTA and SITS data. Our observations suggest a rapid implementation of new data by the medical community and underline the value of analyses of observational data from SITS and VISTA for the very elderly who were excluded or under-represented in the key clinical trials.
- © 2012 by American Heart Association, Inc.