Abstract 115: Improving Door-to-Needle Times in Acute Ischemic Stroke: Interim Findings From Target: Stroke Phase II
Background: The benefits of intravenous tPA in acute ischemic stroke are time-dependent with guidelines recommending a door-to-needle (DTN) time of ≤60 minutes. The implementation of Target: Stroke Phase I in 2010 was associated with an increase in the proportion of patients with DTN times ≤60 minutes in the US from 28.9% in 2009 to 51.0% in 2013. This study aims to assess whether these improvements in DTN times could be maintained or further improved since the launch of Target: Stroke Phase II in Q2 2014.
Methods: Target: Stroke Phase II identified and disseminated additional best practice strategies, provided updated clinical decision support tools, and set new hospital recognition goals. Rates of DTN times ≤60 minutes were compared during final 4 quarters of Phase I (Q4 2012-Q3 2013) vs. Phase II (Q2 2014-Q1 2015) and overall by linear weighted regression.
Results: There were 99,176 intravenous tPA treated patients from 1228 GWTG-Stroke hospitals. Patient characteristics were similar during Phase I and II. Median DTN time significantly declined from the last 4 quarters of Phase I to the first 4 quarters of Phase II: 61 minutes (IQR 47-81) to 57 minutes (IQR 43-74) (P<0.0001). The % of patients with DTN times ≤60 minutes increased from last 4 quarters of Phase I to Phase II: 49.7% to 58.5%, absolute difference +8.8%, (P<0.0001). The % of patients with DTN times ≤45 minutes also increased from Phase I to Phase II: 22.0% to 29.2%, absolute difference +7.2%, (P<0.0001). The estimated annual rate of increase in patients with DTN times ≤60 minutes was 0.6% per year pre-Target Stroke, 5.6% per year during Phase I, and 8.6% in the first year of Phase II (P<0.0001) (Figure).
Conclusions: The timeliness of tPA administration is continuing to improve in GWTG-Stroke hospitals participating in Target: Stroke Phase II. Nevertheless, ongoing quality improvement efforts will be required to meet the goals of ≥75% of patients with DTN times ≤60 minutes and ≥50% of patients with DTN times ≤ 45 minutes.
Author Disclosures: G.C. Fonarow: Employment; Modest; University of California. Research Grant; Modest; PCORI. M. Cox: None. E.E. Smith: None. J.L. Saver: None. M.J. Reeves: Consultant/Advisory Board; Modest; AHA-GWTG Program - Serves as member of several GWTG subcommittees, Consultant to the Michigan Stroke Registry. D.L. Bhatt: Research Grant; Significant; Amarin, AstraZeneca, Bristol-Myers Squibb, Eisai, Ethicon, Forest Laboratories, Ischemix, Medtronic, Roche, Pfizer, Sanofi Aventis, The Medicines Company. Other Research Support; Modest; FlowCo, PLxPharma, Takeda. Consultant/Advisory Board; Modest; Chair of the GWTG Steering Committee, Medscape Cardiology, Regado Biosciences, Boston VA Research Institute, Society of Cardiovascular Patient Care. R. Suter: Employment; Modest; American Heart Association. P.J. Schulte: None. Y. Xian: None. A.F. Hernandez: Research Grant; Modest; Amgen, AstraZeneca, Bayer, Merck, Portorla. Research Grant; Significant; Novartis. Honoraria; Modest; Amgen, AstraZeneca, Merck, Janssen. Honoraria; Significant; Novartis. E.D. Peterson: Research Grant; Modest; Eli Lilly. Research Grant; Significant; Janssen. Consultant/Advisory Board; Modest; Janssen, AstraZeneca, Boehringer Ingelheim, Merck. Consultant/Advisory Board; Significant; Bayer. L.H. Schwamm: Ownership Interest; Modest; LifeImage. Employment; Significant; Medical Director, Mass General TeleHealth. Consultant/Advisory Board; Significant; LifeImage.
This research has received full or partial funding support from the American Heart Association, National Center.
- © 2016 by American Heart Association, Inc.