Target: Stroke Initiative Causes Four-Fold Improvement in Door-to-Needle Times

Target: Stroke, a national quality initiative led by the American Heart Association (AHA) and the American Stroke Association (ASA), was launched in January 2010 to increase the proportion of acute stroke patients with door-to-needle times (DTN) of 60 minutes or less. Results from the initiative were presented Feb. 14 at the International Stroke Conference 2014, and showed that timeliness of tPA administration improved substantially after implementation of the Target: Stroke quality initiative, with a more than four-fold increase in the annual rate of improvement in patients with a DNT time of 60 minutes or less, moving from 1.36 percent to 6.20 percent per year.

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  • The investigators performed a systematic review of hospitals participating in the Get With The Guidelines–Stroke registry with over 71,000 stroke patients treated with tPA. Quarterly rates of DTN times of 60 minutes or less and clinical outcomes of pre-Target: Stroke (2003-2009) were compared to post-Target: Stroke (2010-2013).

    The investigators found that the proportion of patients with DTN times of 60 minutes or less increased from 29.6 percent to 53.3 percent. Such improvements were also accompanied by a lower in-hospital mortality, symptomatic intracranial hemorrhages, and overall tPA complications with more patients being discharged home.

    The investigators conclude that the results of the study would suggest a favorable impact when applying Target: Stroke's various performance improvement techniques, including a single call/paging activation system for the entire stroke team, pre-mixing tPA medication ahead of time for high likelihood candidates, and implementing a more team-based approach.

    "The AHA/ASA Target: Stroke quality initiative has led to an almost doubling in the number of patients with ischemic stroke treated under 60 minutes with thrombolytic therapy," said Deepak L. Bhatt, MD, MPH, FACC, co-author of the study and executive director of interventional cardiovascular programs, Brigham and Women’s Hospital Heart and Vascular Center. "This improvement has been accompanied by lower in-hospital mortality and also lower rates of intracranial bleeding."

    While there are concerns that attempting to achieve shorter DTN times may lead to rushed assessments, dosing errors, and a greater likelihood of complications, the investigators ultimately conclude that their findings suggest that "more rapid reperfusion therapy in acute ischemic stroke is not only feasible, but can be achieved with actual reductions in complications and improved outcomes."

    Keywords: Thrombolytic Therapy, Registries, Stroke, Intracranial Hemorrhages, Hospital Mortality, Tissue Plasminogen Activator, Needles

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