Abstract 86: Progress in Achieving More Rapid 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 and hospitals participating in Target: Stroke have substantially improved the proportion of patients being treated with door-to-needle (DTN) times of ≤60 minutes. However, very few patients were treated with DTN times of ≤45 or ≤30 minutes during Target: Stroke Phase I (2010-2013). This study aims to assess whether there have been greater achievement of DTN times ≤45 and ≤30 minutes 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 ≤45 and ≤30 minutes were compared prior to Target: Stroke (2003-2009), during Phase I (2010-2013), and during Phase II (Q2 2014-present) by weighted linear regression.
Results: There were 131,166 intravenous tPA treated patients from 1397 GWTG-Stroke hospitals. Patient characteristics were similar during the study periods. Median DTN time declined from Phase I to Phase II: 66 minutes (IQR 51-87) to 54 minutes (IQR 41-71) and % of patients with DTN times ≤60 minutes increased from 42.0% to 62.7%, (P<0.0001). The % of patients with DTN times ≤45 minutes increased from Phase I to Phase II: 17.3% to 33.9%, absolute difference +16.6%, (P<0.0001). The % of patients with DTN times ≤30 minutes also increased from Phase I to Phase II: 4.1% to 10.3%, absolute difference +6.2%, (P<0.0001). The estimated annual rate of increase in patients with DTN times ≤45 minutes was 0.25% per year pre-Target Stroke, 3.5% per year during Phase I, and 7.7% per year during Phase II (P<0.0001) (Figure).
Conclusions: There has been accelerating progress in achieving more rapid DTN times for tPA administration among GWTG-Stroke hospitals participating in Target: Stroke Phase II. Nevertheless, opportunities remain to further improve the timeliness of care and clinical outcomes.
Author Disclosures: G.C. Fonarow: Research Grant; Significant; PCORI. M. Cox: None. E. Smith: None. J. Saver: Employment; Modest; Employee of the University of California which has intellectual property rights in a vignette certification system for the modifed Rankin Scale. M. Reeves: None. D. Bhatt: Research Grant; Modest; Marin, Amgen, Astra Zeneca, Bristol-Myers Squibb, Eisai, Ethicon, Forest Laboratories, Ischemix, Medtronic, Pfizer, Roche, Sanofi Aventis, The Medicines Company. Y. Xian: Research Grant; Modest; Genetech. A. Hernandez: Research Grant; Modest; Genetech, Janssen, Bayer, Daiichi, Bristol-Myers Squibb, Pfizer. E. Peterson: Research Grant; Modest; Roche. Other; Modest; PI of AHA GWTG Stroke Data Analysis Center. L. Schwamm: Consultant/Advisory Board; Modest; Massachusetts Department of Public Health. Other; Modest; chair of the AHA/ASA GWTG stroke clinical work group (unpaid). Research Grant; Significant; PI of NINDS trial of delayed window tPA, Genentech provided additional site payments for the NINDS trial. Consultant/Advisory Board; Significant; Penumbra, Medtronic.
This research has received full or partial funding support from the American Heart Association, National Center.
- © 2017 by American Heart Association, Inc.