Exploring the Unmet Need in Acute Ischemic Stroke Patients Not Treated With Intravenous Alteplase: The Get With The Guidelines‐Stroke Registry Article Swipe
Brian Mac Grory
,
Ying Xian
,
Nicole Solomon
,
Roland Matsouaka
,
Marquita Decker‐Palmer
,
Gregg C. Fonarow
,
Eric E. Smith
,
Lee H. Schwamm
·
YOU?
·
· 2021
· Open Access
·
· DOI: https://doi.org/10.1161/svin.121.000226
YOU?
·
· 2021
· Open Access
·
· DOI: https://doi.org/10.1161/svin.121.000226
Background 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. Methods 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). Results 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. Conclusions 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.
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- Type
- article
- Language
- en
- Landing Page
- https://doi.org/10.1161/svin.121.000226
- https://www.ahajournals.org/doi/pdf/10.1161/SVIN.121.000226
- OA Status
- diamond
- Cited By
- 1
- References
- 36
- Related Works
- 10
- OpenAlex ID
- https://openalex.org/W4200249764
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Raw OpenAlex JSON
- OpenAlex ID
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https://openalex.org/W4200249764Canonical identifier for this work in OpenAlex
- DOI
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https://doi.org/10.1161/svin.121.000226Digital Object Identifier
- Title
-
Exploring the Unmet Need in Acute Ischemic Stroke Patients Not Treated With Intravenous Alteplase: The Get With The Guidelines‐Stroke RegistryWork title
- Type
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articleOpenAlex work type
- Language
-
enPrimary language
- Publication year
-
2021Year of publication
- Publication date
-
2021-12-29Full publication date if available
- Authors
-
Brian Mac Grory, Ying Xian, Nicole Solomon, Roland Matsouaka, Marquita Decker‐Palmer, Gregg C. Fonarow, Eric E. Smith, Lee H. SchwammList of authors in order
- Landing page
-
https://doi.org/10.1161/svin.121.000226Publisher landing page
- PDF URL
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https://www.ahajournals.org/doi/pdf/10.1161/SVIN.121.000226Direct link to full text PDF
- Open access
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YesWhether a free full text is available
- OA status
-
diamondOpen access status per OpenAlex
- OA URL
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https://www.ahajournals.org/doi/pdf/10.1161/SVIN.121.000226Direct OA link when available
- Concepts
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Medicine, Stroke (engine), Quartile, Tissue plasminogen activator, Ischemic stroke, Fibrinolytic agent, Emergency medicine, Population, Thrombolysis, Pediatrics, Internal medicine, Myocardial infarction, Ischemia, Confidence interval, Environmental health, Mechanical engineering, EngineeringTop concepts (fields/topics) attached by OpenAlex
- Cited by
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1Total citation count in OpenAlex
- Citations by year (recent)
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2022: 1Per-year citation counts (last 5 years)
- References (count)
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36Number of works referenced by this work
- Related works (count)
-
10Other works algorithmically related by OpenAlex
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