Putting It All Together for Best Stroke Practice, All the Time
See related article, p 1387.
Each year nearly 800 000 people in the United States have a clinically evident stroke. Despite the availability of an effective and time-dependent treatment, intravenous recombinant tissue-type plasminogen activator (r-tPA), in 2011, only 33.8%1 of eligible ischemic stroke patients received treatment within 60 minutes from time of hospital arrival, as recommended by current acute stroke guidelines.2 This suboptimal expediency of treatment, nearly constant for a decade, represents lost opportunity for optimal neurological outcome and reduced mortality. The pooled analyses of the Alteplase Thrombolysis for Acute Noninterventional Therapy in Ischemic Stroke (ATLANTIS), European Cooperative Acute Stroke Study (ECASS), and National Institute of Neurological Disorders and Stroke r-tPA Stroke Study (NINDS) r-tPA trials by Hacke et al3 in 2004 showed a strong association between early treatment and improved outcomes in patients with ischemic stroke treated with r-tPA. A recent analysis of the Get With the Guidelines Stroke registry by Saver et al4 confirmed that earlier treatment yields better patient outcomes.
The American Heart Association/American Stroke Association Target Stroke initiative was created to provide a framework through which hospitals could reduce their door-to-needle (DTN) times. In the development of the Target Stroke program, best practice strategies were identified by a multidisciplinary work group after reviewing published literature and expert consensus. Strategies proven successful in reducing time to treatment of ST-segment–elevation myocardial infarction were identified as best practice strategies that could be easily and effectively adopted by acute care hospitals in the treatment of stroke. Eleven such strategies were promoted, including prehospital notification; the use of single-call stroke team activation; rapid triage, imaging, and laboratory testing; and …