Abstract 1: Patient and Hospital Factors Associated with Lack of IV tPA Use among Eligible Patients with Acute Ischemic Stroke: Findings from Get with the Guidelines-Stroke
BACKGROUND: Nationally representative studies suggest that many eligible patients are not treated with IV tPA. Even among hospitals participating in the Get With The Guidelines (GWTG)-Stroke, treatment rates remain suboptimal. We sought to determine patient and hospital characteristics independently associated with lack of tPA treatment among eligible patients in the GWTG registry.
METHODS: We studied patients with ischemic stroke who arrived ≤2 hours of onset, were tPA-eligible, and had complete data at 1,839 GWTG hospitals from 4/1/03-12/31/11. Eligibility was determined by the lack of documented contraindications/warnings to tPA. Unadjusted and adjusted ORs (computed with GEE logistic regression models to account for hospital clustering of patients) are reported. Due to 28.4% missing NIHSS, GEE models were built with and without NIHSS.
RESULTS: Of 75,115 tPA-eligible patients during the 9-year period, 50,798 (68%) were tPA-treated with median age of 73 years (IQR 60-82), 51% female, 74% non-Hispanic white, and median NIHSS 11. In multivariable models, lack of treatment was associated with older age, females, African-American race, prior diabetes, stroke, or prosthetic heart valve and not arriving by EMS (Table). Treatment was also less likely at hospitals that were rural, non-teaching, in the Midwest and South, and non-stroke centers, earlier in the study period, and at hospitals that did not routinely perform NIHSS (Table). Adding NIHSS to the model (c=0.77 vs. c=0.78) did not change model results substantially but did show reduced tPA use in patients with mild strokes (NIHSS 0-4 vs 5-9, OR 3.4; vs 10-14, OR 4.6; vs 15-20, OR 5.4; vs 21+, OR 4.5).
CONCLUSIONS: One-third of eligible patients at GWTG hospitals did not receive IV tPA treatment. Several patient and hospitals factors were independently associated with this lack of treatment. These findings can inform system interventions to improve tPA treatment among eligible patients.
- © 2012 by American Heart Association, Inc.