The Target: Stroke initiative was associated with faster thrombolytic treatment times and lower 1-year all-cause readmission (40.4% vs 44.1%; HR 0.91, 95% CI 0.88-0.95) for acute ischemic stroke.
Observational (n=42,053)
Yes
Does the Target: Stroke quality initiative improve door-to-needle times and 1-year outcomes in Medicare beneficiaries receiving intravenous thrombolysis for acute ischemic stroke?
The Target: Stroke quality initiative was associated with significantly faster door-to-needle times and modestly lower 1-year all-cause and cardiovascular readmissions in older patients with acute ischemic stroke.
Hazard Ratio: 0.91 (95% CI 0.88–0.95)
Absolute Event Rate: 40.4% vs 44.1%
Background: The benefit of intravenous thrombolytic therapy for acute ischemic stroke is time dependent. To assist hospitals in providing faster thrombolytic treatment, the American Heart Association launched target: stroke quality initiative in January 2010 which disseminated feasible strategies to shorten door-to-needle times for thrombolytic therapy. This study aimed to examine whether target: stroke was associated with improved door-to-needle times and 1-year outcomes. Methods: We analyzed Medicare beneficiaries aged ≥65 years receiving intravenous thrombolytic treatment for acute ischemic stroke at 1490 Get With The Guidelines-Stroke hospitals during January 2006 and December 2009 (preintervention, n=10 804) and January 2010 and December 2014 (postintervention, n=31 249). The median age was 80 years and 42.7% were male. Results: The median door-to-needle times decreased from 80 minutes for the preintervention to 68 minutes for the postintervention ( P <0.001). The proportion of patients receiving intravenous thrombolysis with door-to-needle times 45 minutes and 60 minutes increased from 9.6% and 24.8% for preintervention to 17.1% and 40.6% for postintervention, respectively ( P <0.001). The annual rate of increase in the door-to-needle times of 60 minutes or less accelerated from 0.20% (95% CI, −0.43% to 0.83%) per each 4 quarters for preintervention to 5.68% (95% CI, 5.23%–6.13%) for postintervention ( P <0.001) which was further confirmed in piecewise multivariable generalized estimating analysis (adjusted odds ratio, 1.27 95% CI, 1.19–1.35). Cox proportional hazards analysis, after adjusting for patient and hospital characteristics and within-hospital clustering, showed that target: stroke was associated with lower all-cause readmission (40.4% versus 44.1%; hazard ratio, 0.91 95% CI, 0.88–0.95), cardiovascular readmission (19.7% versus 22.9%; hazard ratio, 0.85 95% CI, 0.80–0.89), and composite of all-cause mortality or readmission (56.0% versus 58.4%; hazard ratio, 0.96 95% CI, 0.93–1.00). The risk decline in all-cause mortality dissipated after risk adjustment (adjusted hazard ratio, 0.98 95% CI, 0.94–1.02). Conclusions: Target: stroke quality initiative was associated with faster thrombolytic treatment times for acute ischemic stroke and modestly lower 1-year all-cause and cardiovascular readmissions.
Man et al. (Tue,) conducted a observational in Acute ischemic stroke (n=42,053). Target: Stroke quality initiative vs. Preintervention period (January 2006 to December 2009) was evaluated on 1-year all-cause readmission (HR 0.91, 95% CI 0.88-0.95). The Target: Stroke initiative was associated with faster thrombolytic treatment times and lower 1-year all-cause readmission (40.4% vs 44.1%; HR 0.91, 95% CI 0.88-0.95) for acute ischemic stroke.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: