18 Feb Target: Stroke Program Improved Stroke Treatment Time and Outcomes
MedicalResearch.com Interview with:
Gregg C Fonarow, UCLA Medical Ctr, Los Angeles, CA;
Director, Ahmanson-UCLA Cardiomyopathy Center
Professor, Department of Medicine
Associate Chief, Cardiology
David Geffen School of Medicine
MedicalResearch.com: What are the main findings of the study?
Dr. Fonarow: The study examined data from hospitals that have adopted the American Heart Association/ American Stroke Association’s national quality initiative, Target: Stroke. The primary aim of Target: Stroke is to increase the number of stroke patients treated with tPA for acute ischemic stroke within 60 minutes or less after hospital arrival. The study demonstrated that patients received stroke therapy significantly faster in hospitals that participated in Target: Stroke. Between 2010 and 2013, the time between hospital arrival and use of tPA (door-to-needle time) dropped by 15 minutes, from 74 to 59 minutes, in hospitals that participated in Target: Stroke. This study found that the percentage of patients treated within the recommended timeframe increased from less than one-third before Target: Stroke to more than half afterwards. The Target: Stroke program goal of 50 percent or more of patients having door-to-needle times within 60 minutes was successfully achieved. Faster treatment was associated with improved patient outcomes and fewer complications, including death.
MedicalResearch.com: Were any of the findings unexpected?
Dr. Fonarow: It was surprising that the quality improvement intervention was so successful in all types of patients including young and older, men and women, white, black, and Hispanic patients as well as those with greater and lesser stroke severity.
MedicalResearch.com: What should clinicians and patients take away from your report?
Target: Stroke was successful. The timeliness of tPA administration improved substantially after initiation of the multidimensional AHA/ASA Target: Stroke quality initiative. The proportion of patients with door-to-needle times ≤60 minutes increased from 29.6% to 53.3%. There was also a more than 4-fold increase in the annual rate of improvement in patients with door-to-needle time ≤60 minutes. This improvement was accompanied by lower in-hospital mortality, symptomatic intracranial hemorrhage, and overall tPA complications with more patients able to be discharged to home.
MedicalResearch.com: What recommendations do you have for future research as a result of this study?
Dr. Fonarow: These findings further reinforce the importance and clinical benefits of faster administration of intravenous tPA. By showing that the timeliness of tPA administration can be improved at the national level, these findings also support further expansion of the Target: Stroke initiative. Future studies should evaluate hospital and systems factors associated with the greatest improvement in performance.
International Stroke Conference 2014: Abstract LB 12
Title: Improving Door-to-Needle Times in Acute Ischemic Stroke: Principal Results from the Target: Stroke Initiative
Authors: Gregg C Fonarow, UCLA Medical Ctr, Los Angeles, CA; Xin Zhao, Duke Clinical Res Inst, Durham, NC; Eric E. Smith, Univ of Calgary, Calgary, AB, Canada; Jeffrey L. Saver, UCLA Neurology, Los Angeles, CA; Mathew J. Reeves, Michigan State Univ, East Lansing, MI; Deepak L. Bhatt, Brigham and Women’s Hosp, Boston, MA; Ying Xian, Adrian Hernandez, Eric D. Peterson, Duke Clinical Res Inst, Durham, NC; Lee H. Swhwamm, Massachusetts General Hosp, Boston, MA