Abstract WMP86: Reasons for Slower Door-to-Needle Times and Their Impact on Timing of Treatment and Outcomes: Findings From Get With The Guidelines-Stroke
Background: Despite quality improvement programs such as the American Heart Association/American Stroke Association Target_Stroke initiative, a substantial portion of acute ischemic stroke patients are still treated with alteplase later than 60 minutes, for unclear reasons. This study aims to describe the documented reasons for delays as well as the associations between reasons for delays and patient outcomes.
Methods: We analyzed 55,296 patients who received intravenous alteplase in 1,422 hospitals participating in Get With The Guidelines-Stroke from October 2012 to April 2015, excluding transferred patients and inpatient strokes. We assessed eligibility, medical, and hospital reasons for delays in door-to-needle time (DTN). Multivariable models were used to evaluate associations between reasons for delays, time lost, and hospital discharge outcomes, controlling for patient and hospital characteristics.
Results: There were 27,778 (50.2%) patients treated within 60 minutes, 10,086 (18.2%) treated in more than 60 minutes without documented delays, and 17,432 (31.5%) treated in more than 60 minutes with one or more documented reasons for delay. The longest DTN times were associated with inability to determine eligibility, delay in diagnosis, further diagnostic evaluation for hypoglycemia or seizure, management of emergent medical conditions and initial patient refusal (Table). One or more reason for delays was associated with in-hospital mortality (OR 1.2; 95CI 1.1-1.3), symptomatic intracranial hemorrhage (OR 1.2; 95CI 1.1-1.3), and lower odds of independent ambulation at discharge (OR 0.92; 95CI 0.9-1.0).
Conclusions: Hospital and eligibility delays such as delay in diagnosis and inability to determine eligibility are common and are associated with longer DTN and poorer outcomes. Improved stroke recognition and management of acute comorbidities may help to reduce DTN times and improve outcomes.
Author Disclosures: N. Kamal: None. S. Sheng: None. M.D. Hill: Honoraria; Modest; Boehringer Ingelheim, BMS-Pfizer, Bayer Canada. Ownership Interest; Modest; Calgary Sciencific Inc.. Consultant/Advisory Board; Modest; Merck LLC. Research Grant; Significant; Medtronic LLC, Stryker, Bayer Canada, Boehringer Ingelheim. Other Research Support; Significant; Alberta Innovates Health Solutions. Y. Xian: Research Grant; Modest; Dr. Xian reports research grant directed to the Duke Clinical Research Institute from Genentech.. L.H. Schwamm: None. D.L. Bhatt: Honoraria; Modest; : American College of Cardiology (Senior Associate Editor, Clinical Trials and News, ACC.org), Belvoir Publications (Editor in Chief, Harvard Heart Letter), Duke Clinical Research Institute (clinical. Consultant/Advisory Board; Modest; Cardax, Elsevier Practice Update Cardiology, Medscape Cardiology, Regado Biosciences. Other; Modest; Clinical Cardiology (Deputy Editor), NCDR-ACTION Registry Steering Committee (Chair), VA CART Research and Publications Committee (Chair); Research Funding: Amarin, Amgen, AstraZeneca, Bristol-Myers S. G.C. Fonarow: Employment; Modest; University of California which has a patent on an endovascular therapy device. Research Grant; Modest; Patient Centered Outcome Research Institute. Other; Modest; member of the GWTG Steering Committee. R. Matsouaka: None. J.L. Saver: None. M.J. Reeves: None. E.E. Smith: Other; Modest; member of the GWTG Steering Committee, and serving on a Data Safety and Monitoring Board for Massachusetts General Hospital.
- © 2017 by American Heart Association, Inc.