Background & Objectives: Timely administration of IV Alteplase in ischemic stroke patients can lead to reduction in the severity of disability and improve patient outcomes. The treatment window for IV Alteplase is within 3 hours of last known well (LKW) and up to 4.5 hours in certain eligible patients. Community education of the message “time is brain” is a critical component in the chain of survival for stroke patients. The American Heart Association and the American Stroke Association have focused community awareness efforts on signs & symptoms recognition and the importance of acting F.A.S.T. © when stroke symptoms occur. Our objective is to determine if ischemic stroke patients are arriving to the hospital within the timeframe to be eligible for IV Alteplase treatment.
Methods: Get With the Guidelines (GWTG) -Stroke® is a quality improvement initiative to improve care by promoting adherence to scientific guidelines. A retrospective review was conducted of 337, 407 ischemic stroke patients from over 325 hospitals using GWTG-Stroke® in the Midwest from 2011 through 2016. LKW to hospital arrival times were analyzed.
Results: The percentage of patients arriving within 3 hours of LKW was as follows: 23.3% in 2011, 22.5% in 2012, 23.1% in 2013, 22.5% in 2014, 23.4% in 2015, and 23.3% in 2016. The percentage of patients arriving within 4.5 hours of LKW: 29.1% in 2011, 28.2 % in 2012, 28.9% in 2013, 28.4% in 2014, 29.5% in 2015, 29.4% in 2016.
Conclusions: Throughout the six years of this study, an average of only 23% of ischemic stroke patients arrived to the hospital within 3 hours of LKW, with slightly more, 29%, of patients arriving within the extended window (4.5 hrs of LKW) to be considered eligible for IV Alteplase treatment. With greater than 70% of patients arriving too late to receive this clot-busting drug, this data identifies the continued need for community education regarding acting F.A.S.T.© in recognizing signs and symptoms of stroke.