Stroke patients receive better care when hospitals 'get with the g...( mm examined clot-buster and early aspi...),Health

mm, examined clot-buster and early aspirin use in patients presenting with acute ischemic stroke. Researchers monitored the percentage of eligible stroke patients arriving within two or three hours of symptom onset who received timely treatment with intravenous tPA, the standard FDA-approved clot-busting therapy. They also monitored how many patients were treated with aspirin-like drugs or anticoagulants within 48 hours, and the number documented as ineligible for intravenous tPA treatment.

The researchers emphasized the use of tPA within 60 minutes, and monitoring symptomatic systemic or intracranial hemorrhage. Data were documented at baseline and for four subsequent quarters.

Results showed that GWTGStroke implementation was associated with a dramatic 89 percent improvement in rates of intravenous tPA use in eligible patients who came in within two hours of symptoms, without an increase in bleeding complications. By the fourth quarter, 85 percent of all acute stroke patients who did not receive IV tPA had a documented reason for ineligibility. The study also showed that reducing door-to-needle time remains a challenge, but Schwamm said that the GWTG-Stroke program addresses the type of "rapid cycle improvement" needed to target this problem.

"It's the first program that has been able to show this much improvement in stroke care so rapidly across this scope and scale of patients and hospitals," he said.

"Guidelines by themselves are not successful in changing practice. However, guidelines tied to individual patients at the point of care can have an impact. This program helps bridge the gap between what we know and what we do."

Co-authors for both studies are Dawn G. Albright; Michael Frankel, M.D.; Irene Katzan, M.D.; Ali Malek, M.D.; Mathew Reeves and Scott E. Kasner, M.D.

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Contact: Carole Bullock
carole.bullock@heart.org
214-706-1279
American Heart Association
2-Feb-2005

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