Exploring the Unmet Need in Acute Ischemic Stroke Patients Not Treated With Intravenous Alteplase: The Get With The Guidelines‐Stroke Registry

Mac Grory, Brian

Xian, Ying

Solomon, Nicole C

Matsouaka, Roland A

Decker‐Palmer, Marquita R

Fonarow, Gregg C

Smith, Eric E

Schwamm, Lee H

2024-06-06T15:25:03Z

2024-06-06T15:25:03Z

2022-01

<jats:sec xml:lang="en"> <jats:title>Background</jats:title> <jats:p xml:lang="en">Early administration of intravenous tissue plasminogen activator (IV alteplase) improves functional outcomes in patients with acute ischemic stroke, yet many patients are not treated with IV alteplase. There is a need to understand the reasons for nontreatment and the short‐ and long‐term outcomes in this patient population.</jats:p> </jats:sec> <jats:sec xml:lang="en"> <jats:title>Methods</jats:title> <jats:p xml:lang="en">We analyzed patients ≥65 years old with a primary diagnosis of acute ischemic stroke presenting within 24 hours of time last known well (LKW) but not treated with IV alteplase from 1630 Get With The Guidelines‐Stroke hospitals in the United States between January 2016 and December 2016. We report clinical characteristics, reasons for withholding treatment, in‐hospital mortality, and 90‐day and 1‐year outcomes including costs, stratified by time from LKW to presentation (≤4.5, >4.5–6, and >6–24 hours).</jats:p> </jats:sec> <jats:sec xml:lang="en"> <jats:title>Results</jats:title> <jats:p xml:lang="en">Of 39 760 patients (median age 80 [25th–75th quartiles: 73–87], 56.7% female), 19 391 (48.8%) presented within 4.5 hours of LKW. In those with documented reasons for withholding IV alteplase, the most common reasons were rapid improvement of symptoms (3985/14 782, 27.0%) and mild symptoms (3791/14 782, 25.6%). In 1100 out of 1174 (93.7%) patients presenting in the >3.0‐ to 4.5‐hour time window, the most common reason for not treating was a delay in patient arrival. The most common discharge location for those presenting ≤4.5 hours since LKW was home (8660/19 391, 44.7%). The 90‐day mortality and readmission rates were 18.9% and 23.0% in those presenting ≤4.5 hours since LKW, 19.0% and 22.2% in those presenting between 4.5 and 6 hours, and 19.1% and 23.2% in those presenting between 6 and 24 hours. Median 90‐day total in‐hospital costs remained relatively high at $9471 (Q25–Q75: $5622–$21 356) in patients presenting ≤4.5 hours since LKW.</jats:p> </jats:sec> <jats:sec xml:lang="en"> <jats:title>Conclusions</jats:title> <jats:p xml:lang="en">Patients within the Get With The Guidelines‐Stroke registry not treated with IV alteplase have a high risk of readmission and mortality and have high total in‐hospital and postdischarge costs. This study may inform future efforts to address the unmet need to improve the scope of IV alteplase delivery along with other aspects of acute ischemic stroke care and, consequently, outcomes in this patient population.</jats:p> </jats:sec>

2694-5746

2694-5746

https://hdl.handle.net/10161/31138

en

Ovid Technologies (Wolters Kluwer Health)

Stroke: Vascular and Interventional Neurology

10.1161/svin.121.000226

https://creativecommons.org/licenses/by-nc/4.0

Exploring the Unmet Need in Acute Ischemic Stroke Patients Not Treated With Intravenous Alteplase: The Get With The Guidelines‐Stroke Registry

Journal article

Mac Grory, Brian|0000-0003-3914-8419

Solomon, Nicole C|0000-0002-5643-9958

Matsouaka, Roland A|0000-0002-0271-5400

1

Duke

School of Medicine

Staff

Basic Science Departments

Clinical Science Departments

Institutes and Centers

Biostatistics & Bioinformatics

Ophthalmology

Duke Clinical Research Institute

Neurology

Neurology, Stroke and Vascular Neurology

Biostatistics & Bioinformatics, Division of Biostatistics

Published

2