Background: There is emphasis on understanding the implementation of clinical trial results for clinical practice. The aim of this study is to examine the changes in endovascular procedures utilization after the publication of the recent clinical trials showing benefit of such procedures in patients with acute ischemic stroke (AIS).
Methods: Minnesota Hospital Association (MHA) database was used to calculate the state wide utilization rates for two periods: prior to (January 1st-December 31st, 2014) and after (January 1st-December 31st, 2015) publication of randomized clinical trials. MHA collects data from 137 member hospitals for monitoring and reporting healthcare quality and cost across the state. Patients with admitting diagnosis of AIS and those who received endovascular treatment were identified using ICD9 or ICD10 codes. Utilization rates for endovascular treatment were calculated monthly, quarterly, and annually. Discharge to home was considered as the measure of none to minimal disability.
Results: Of the 13,043 patients admitted with the diagnosis of AIS, 434 patients (mean age 68.5± 25.5 years; 51.2% women) received endovascular treatment. The number of procedures increased from 194 in 2014 to 240 in 2015. Utilization rate was 3.4% in the first quarter of 2014, gradually declined to reach its lowest value (2.6%) in the last quarter of 2014, then steadily increased to reach its peak (4%) in the last quarter of 2015. Procedures performed at comprehensive stroke centers increased from 52% of total procedures in 2014 to 57.5% in 2015 while those performed at primary stroke centers decreased from 22.6% in 2014 to 19.5% in 2015. In 2015, fewer patients had hypertension (50.4% vs. 60.3%; p=0.039) and more patients had chronic kidney disease (28.3% vs. 15.5%; p=0.001). Intracranial hemorrhage and mortality rates were not significantly different between the two years. There was a trend towards higher rate of minimal or no disability at discharge among patients treated in 2015 compared with those treated in 2014 (22.5% versus 18.1%, p=0.25).
Conclusion: We observed a state wide increase in rate of utilization of endovascular treatment of AIS patients coinciding with the publication of the results of new clinical trials.