Background: The benefits of intravenous tPA in acute ischemic stroke are time-dependent and hospitals participating in Target: Stroke have substantially improved the proportion of patients being treated with door-to-needle (DTN) times of ≤60 minutes. However, very few patients were treated with DTN times of ≤45 or ≤30 minutes during Target: Stroke Phase I (2010-2013). This study aims to assess whether there have been greater achievement of DTN times ≤45 and ≤30 minutes since the launch of Target: Stroke Phase II in Q2 2014.
Methods: Target: Stroke Phase II identified and disseminated additional best practice strategies, provided updated clinical decision support tools, and set new hospital recognition goals. Rates of DTN times ≤45 and ≤30 minutes were compared prior to Target: Stroke (2003-2009), during Phase I (2010-2013), and during Phase II (Q2 2014-present) by weighted linear regression.
Results: There were 131,166 intravenous tPA treated patients from 1397 GWTG-Stroke hospitals. Patient characteristics were similar during the study periods. Median DTN time declined from Phase I to Phase II: 66 minutes (IQR 51-87) to 54 minutes (IQR 41-71) and % of patients with DTN times ≤60 minutes increased from 42.0% to 62.7%, (P<0.0001). The % of patients with DTN times ≤45 minutes increased from Phase I to Phase II: 17.3% to 33.9%, absolute difference +16.6%, (P<0.0001). The % of patients with DTN times ≤30 minutes also increased from Phase I to Phase II: 4.1% to 10.3%, absolute difference +6.2%, (P<0.0001). The estimated annual rate of increase in patients with DTN times ≤45 minutes was 0.25% per year pre-Target Stroke, 3.5% per year during Phase I, and 7.7% per year during Phase II (P<0.0001) (Figure).
Conclusions: There has been accelerating progress in achieving more rapid DTN times for tPA administration among GWTG-Stroke hospitals participating in Target: Stroke Phase II. Nevertheless, opportunities remain to further improve the timeliness of care and clinical outcomes.