- Use of reperfusion therapy among patients with acute stroke having in-hospital onset more than doubled during a recent decade, but time to use was slower and outcomes were poorer than for patients having out-of-hospital onset.
Why this matters
- Up to 10.8% of acute ischemic strokes occur among hospitalized patients.
- Contemporary use of reperfusion therapy and outcomes in this population are unknown.
- Editorial notes that "treatment can be better" and says the findings support broadening education and relevant protocols to regional stroke systems and healthcare professionals outside of neurology and emergency care.
- Between 2008 and 2018, patients with in-hospital stroke saw increased use of:
- Intravenous thrombolysis (from 9.1% to 19.1%; P<.001>
- Endovascular therapy (from 2.5% to 6.9%; P<.001>
- Cranial imaging (33 vs 16 minutes; P<.001>
- Thrombolysis bolus (81 vs 60 minutes; P<.001>
- Less likely to ambulate independently at discharge (aOR, 0.78; P<.001>
- More likely to die or be discharged to hospice (aOR, 1.39; P<.001>
- US retrospective cohort study of patients undergoing reperfusion therapy for stroke 2008-2018 (national registry):
- 2,170,250 with out-of-hospital onset.
- 67,493 with in-hospital onset.
- Main outcomes: trends use of reperfusion therapy, process measures of quality, association of functional outcomes with patient factors.
- Funding: American Heart Association; Novartis; others.
- Indication for hospital admission was unknown.
- Potential reporting bias.
- Unknown generalizability.