Introduction: Reperfusion therapies are the optimal treatment for acute ischemic stroke (AIS). Their effectiveness is highly time-dependent. Worldwide, organized stroke care has shown to improve efficiency and quality of attention in stroke management. Neither reperfusion therapies or stroke center care have been widely implemented in Mexico. The objective of this study is to describe whether the implementation of a Stroke Care Program (ABC Stroke Center) improved time to treatment and adherence to Get With The Guidelines parameters on patients who underwent IV thrombolysis for AIS.
Hypothesis: Implementation of an institutional Stroke Program lowers door-to-needle time (DNT) and improves adherence to stroke quality measures in patients treated with IV thrombolysis.
Methods: The study included all patients with AIS diagnosis treated with IV thrombolysis between January 2010 and May 2016. We then compared patients admitted before and after June 2014 (start of the Stroke Program).
Results: A total of 56 patients were included, 30 (53.6%) were admitted preintervention and 26 (46.4%) postintervention. All of them were treated with IV thrombolysis. All time parameters related to quality of attention were shorter in patients after the Stroke Program started. DNT was 21 minutes shorter in the Stroke Program group (mean 65 vs 86 min, p<0.03), and the number of patients within the DNT time goal of 60 minutes was larger postintervention (44.8 vs 29.6%, (95%CI 0.76 - 2.6, p=0.24)]. Adherence to stroke quality measures was more common in the Stroke Program group. Patients included after the start of the stroke program had a higher NIHSS score upon discharge. The probability of a good outcome (mRS<3) upon discharge was higher in the Stroke Program group (61.1% vs 31.4%) [RR = 1.9 (95%CI 1.17 - 3.38)].
Conclusions: Implementation of a Stroke Care program diminished DNT significantly and improved adherence to stroke quality measures. This may result on better outcomes for AIS patients.