Implementation of regional Acute Stroke Care Map increases thrombolysis rates for acute ischaemic stroke in Chinese urban area in only 3 months.
Abstract
BACKGROUND:The rate of intravenous thrombolysis for acute ischaemic stroke remains
low in China. We investigated whether the implementation of a citywide Acute Stroke
Care Map (ASCaM) is associated with an improvement of acute stroke care quality in
a Chinese urban area. METHODS:The ASCaM comprises 10 improvement strategies and has
been implemented through a network consisting of 20 tertiary hospitals. We identified
7827 patients with ischaemic stroke admitted from April to October 2017, and 506 patients
underwent thrombolysis were finally included for analysis. RESULTS:Compared with 'pre-ASCaM
period', we observed an increased rate of administration of tissue plasminogen activator
within 4.5 hours (65.4% vs 54.5%; adjusted OR, 1.724; 95% CI 1.21 to 2.45; p=0.003)
during 'ASCaM period'. In multivariate analysis models, 'ASCaM period' was associated
with a significant reduction in onset-to-door time (114.1±55.7 vs 135.7±58.4 min,
p=0.0002) and onset-to-needle time (ONT) (169.2±58.1 vs 195.6±59.3 min, p<0.0001).
Yet no change was found in door-to-needle time. Clinical outcomes such as symptomatic
intracranial haemorrhage, favourable functional outcome (modified Rankin Scale ≤2)
and in-hospital mortality remained unchanged. CONCLUSION:The implementation of ASCaM
was significantly associated with increased rates of intravenous thrombolysis and
shorter ONT. The ASCaM may, in proof-of-principle, serve as a model to reduce treatment
delay and increase thrombolysis rates in Chinese urban areas and possibly other highly
populated Asian regions.
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https://hdl.handle.net/10161/21567Published Version (Please cite this version)
10.1136/svn-2020-000332Publication Info
Sui, Yi; Luo, Jianfeng; Dong, Chunyao; Zheng, Liqiang; Zhao, Weijin; Zhang, Yao; ...
Xu, Bing (2020). Implementation of regional Acute Stroke Care Map increases thrombolysis rates for
acute ischaemic stroke in Chinese urban area in only 3 months. Stroke and vascular neurology. 10.1136/svn-2020-000332. Retrieved from https://hdl.handle.net/10161/21567.This is constructed from limited available data and may be imprecise. To cite this
article, please review & use the official citation provided by the journal.
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Show full item recordScholars@Duke
Ying Xian
Associate Professor in Neurology
Dr. Xian is an Associate Professor of Neurology and Medicine at the Duke University
Medical Center and Duke Clinical Research Institute. He received his Medical Degree
from Beijing Medical University (Peking University Health Science Center) and completed
an Internal Medicine Residency and Cardiology Fellowship at Peking University People’s
Hospital, and Fuwai Hospital, Peking Union Medical College. Dr. Xian’s research is
dedicated to improving health care quality and outcomes in

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