Abstract 158: Temporal Trends in tPA Administration Among Very Elderly Hospitalized with Ischemic Stroke in the United States
Background: Rates of tPA administration in very elderly (age≥80) have historically been lower than the general population, perhaps due to their under-representation in thrombolysis stroke trials. While the population of very elderly individuals is rapidly growing, nationwide trends in tPA administration and stroke outcomes in this group have not been well described.
Methods: Data were obtained from all US states that contributed to the Nationwide Inpatient Sample. All patients (N=5,959,914) admitted to hospitals between 2000 and 2010 with a discharge diagnosis of ischemic stroke (ICD9 codes) were included. Primary analysis was the proportion of patients who received tPA administration stratified by age (18-64yo, 65-79yo, ≥80yo) temporally. Survey-weighted Poisson regression was used to estimate the standardized rate for each year and compare the trend for yearly change between age categories.
Result: Hospitalizations for acute stroke in the US were roughly split 1/3 into each age category: 80 years of age or older (35%), between 65 to 79 years of age (37%), and 18 to 64 years of age (28%). tPA administration rate increased by year from 2000 to 2010 regardless of age. In 2000, tPA administration rate was 1.02%, 0.92%, 0.47% in patients aged 18-64, 65-79yo, ≥80 years of age, respectively. In 2010, tPA administration rate was 3.61%, 3.87%, 3.55%, respectively. The magnitude of change was the greatest in very elderly individuals age 80 or older with the rate of increase of 1.25 (1.25-1.26), compared to other age groups 1.15 (1.15-1.16) for age 18-64yo, and 1.17 (1.17-1.18) for age 65-79yo.
Conclusion: Over the last decade, the rate of tPA administration for acute ischemic stroke in the United States have increased for every age group. The magnitude of increase was the greatest in very elderly individuals aged 80 or above. Given the rapidly ageing US population, avenues for improving safe and effective administration of tPA among very elderly with stroke need to be further explored.
Author Disclosures: M.P. Lin: None. S. Cen: None. A. Towfighi: None. M. Kim-Tenser: None. W.J. Mack: None. N. Sanossian: None.
- © 2015 by American Heart Association, Inc.