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By Christina Thielst
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Blog: http://thielst.typepad.com/my_weblog/
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Lower Door-to-Needle Times for Acute Stroke Show Better Clinical Outcomes

Posted Feb 10 2011 12:00am
Gregg C. Fonarow, M.D., professor of cardiovascular medicine at the University of California-Los Angeles is lead author of the Timeliness of tPA Therapy in Acute Ischemic Stroke:  Patient Characteristics, Hospital Factors and Outcomes Associated with Door-to-Needle Times within 60 Minutes   The study results, released today at the International Stroke Conference, examine the health delivery system and identify these key (to me) points:
  • analysis demonstrates that a minority of patients treated with intravenous tPA receive this therapy within 60 minutes of arrival
  • those... arriving during off-hours were particularly less likely to receive timely care
  • hospitals with less experience in providing tPA to ischemic stroke patients were less likely to provide thrombolytic therapy within 60 minutes
  • there was no evidence of worse in-hospital outcomes or increased bleeding complications from tPA for patients with door-to-needle times of less that 60 minutes compared with those with door-to-needle times of greater than 60 minutes
  • in-hospital mortality was lower among those patients treated in a more timely fashion, even after extensive risk adjustment.   
This last point hits home, because hospital mortality rates for acute stroke are by far the highest in the State of California and my home region's rates are even worse.  I agree with the authors that these findings lend support for a targeted initiative to shorten door-to-needle times in acute ischemic stroke to maximize the clinical benefit and a few of us are attempting to do just this for our the tri-county region.  Stay tuned!
Listen to Dr. Fonarow's  audio recording of his study results
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