1
|
Tu WJ, Yan F, Chao BH, Ma L, Ji XM, Wang LD. Thrombolytic DNT and fatality and disability rates in acute ischemic stroke: a study from Bigdata Observatory Platform for Stroke of China. Neurol Sci 2021; 43:677-682. [PMID: 34480243 DOI: 10.1007/s10072-021-05580-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 08/23/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To evaluate whether shorter door-to-needle times (DNT) with intravenous tissue plasminogen activator (tPA) for acute ischemic stroke are associated with improved 1-year outcomes in Chinese patients. METHODS From August to September 2019, all first-ever ischemic stroke patients who were treated with intravenous tPA within 4.5 h of the time they were last known to be well from 232 hospitals in China were included. Patients were divided into four groups according to DNT time (≤ 45 min; 45-60 min; 60-90 min; > 90 min). All discharged patients would receive a telephone follow-up at 12-month after admission. Death and disability events were recorded. RESULTS Finally, 2370 patients were analyzed. The median age was 65 years, 66.6% were male, and 2.4% were of ethnic minorities. In the 1-year follow-up, 211 patients died (8.9%; 95%CI: 7.8-10.0%). The patients (53.1%) had DNT times of longer than 45 min, compared with those treated within 45 min, did not have significantly higher 1-year mortality (8.9% vs 8.9% [absolute difference, 0.03% {95% CI, - 0.05% to - 0.10%}, odd ratio {OR}, 1.00 {95% CI, 0.75 to 1.33}]). In addition, 385 patients (16.2%; 14.8-17.3%) out of those survivors had disability events. The patients had DNT times of longer than 45 min, compared with those treated within 45 min, did not have significantly higher 1-year disability rate (18.9% vs 16.7% [absolute difference, 1.9% {95% CI, 1.1% to 3.0%}, odd ratio {OR}, 1.22 {95% CI, 0.89 to 1.43}]). CONCLUSIONS The results did not show that shorter DNT for tPA administration was significantly associated with better 1-year outcomes.
Collapse
Affiliation(s)
- Wen-Jun Tu
- The General Office of Stroke Prevention Project Committee, National Health Commission of the People's Republic of China, No. 118, Guang'anmen Inner Street, Beijing, 100053, China.,Institute of Radiation Medicine, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, 300192, China.,Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Feng Yan
- Department of Neurosurgery, Xuanwu Hospital Capital Medical University, Beijing, China
| | - Bao-Hua Chao
- The General Office of Stroke Prevention Project Committee, National Health Commission of the People's Republic of China, No. 118, Guang'anmen Inner Street, Beijing, 100053, China
| | - Lin Ma
- Department of Interventional Radiology, Shanghai Tongji Hospital, Tongji University School of Medicine, Shanghai, China
| | - Xun-Ming Ji
- Department of Neurosurgery, Xuanwu Hospital Capital Medical University, Beijing, China
| | - Long-De Wang
- The General Office of Stroke Prevention Project Committee, National Health Commission of the People's Republic of China, No. 118, Guang'anmen Inner Street, Beijing, 100053, China.
| |
Collapse
|
2
|
Vieira LGDR, Safanelli J, Araujo TD, Schuch HA, Kuhlhoff MHR, Nagel V, Conforto AB, Silva GS, Mazin S, Cabral NL. The cost of stroke in private hospitals in Brazil: a one-year prospective study. ARQUIVOS DE NEURO-PSIQUIATRIA 2019; 77:393-403. [PMID: 31314841 DOI: 10.1590/0004-282x20190056] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Accepted: 02/12/2019] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Few studies from low- and middle-income countries have assessed stroke and cerebral reperfusion costs from the private sector. To measure the in-hospital costs of ischemic stroke (IS), with and without cerebral reperfusion, primary intracerebral hemorrhage (PIH), subarachnoid hemorrhage (SAH) and transient ischemic attacks (TIA) in two private hospitals in Joinville, Brazil. METHODS Prospective disease-cost study. All medical and nonmedical costs for patients admitted with any stroke type or TIA were consecutively determined in 2016-17. All costs were adjusted to the gross domestic product deflator index and purchasing power parity. RESULTS We included 173 patients. The median cost per patient was US$3,827 (IQR: 2,800-8,664) for the 131 IS patients; US$2,315 (IQR: 1,692-2,959) for the 27 TIA patients; US$16,442 (IQR: 5,108-33,355) for the 11 PIH patients and US$28,928 (IQR: 12,424-48,037) for the four SAH patients (p < 0.00001). For the six IS patients who underwent intravenous thrombolysis, the median cost per patient was US$11,463 (IQR: 8,931-14,291), and for the four IS patients who underwent intra-arterial thrombectomy, the median cost per patient was US$35,092 (IQR: 31,833-37,626; p < 0.0001). A direct correlation was found between cost and length of stay (r = 0.67, p < 0.001). CONCLUSIONS Stroke is a costly disease. In the private sector, the costs of cerebral reperfusion for IS treatment were three-to-ten times higher than for usual treatments. Therefore, cost-effectiveness studies are urgently needed in low- and middle-income countries.
Collapse
Affiliation(s)
| | - Juliana Safanelli
- Universidade da Região de Joinville, Joinville, SC, Brasil.,Registro de AVC de Joinville, Joinville, SC, Brasil
| | | | | | | | - Vivian Nagel
- Registro de AVC de Joinville, Joinville, SC, Brasil
| | - Adriana Bastos Conforto
- Universidade de São Paulo, Divisão de Clínica Neurológica, São Paulo, SP, Brasil.,Hospital Israelita Albert Einstein, São Paulo, SP, Brasil
| | - Gisele Sampaio Silva
- Universidade de São Paulo, Divisão de Clínica Neurológica, São Paulo, SP, Brasil.,Hospital Israelita Albert Einstein, São Paulo, SP, Brasil
| | - Suleimy Mazin
- Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Ribeirão Preto, SP, Brasil
| | - Norberto Luiz Cabral
- Universidade da Região de Joinville, Joinville, SC, Brasil.,Registro de AVC de Joinville, Joinville, SC, Brasil
| |
Collapse
|
3
|
The Impact of Transferring Stroke Patients: An Analysis of National Administrative Data. Can J Neurol Sci 2016; 43:760-764. [PMID: 27619350 DOI: 10.1017/cjn.2016.285] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Interhospital transfer is an important but resource-intensive pattern of care. The use for stroke patients is highly dependent upon health system structure. We examined the impact of hospital transfers for stroke care in Canada. METHODS We analyzed hospital administrative data within the Canadian Institute for Health Information (CIHI) Database for the 3 fiscal years 2011/12, 2012/13 and 2013/14. Patients with clinical stroke syndrome (ischemic or hemorrhagic) were identified using International Classification of Diseases. Stroke centers were defined by Heart & Stroke Foundation of Canada stroke report. RESULTS During the 3-year period,397 patients in Canada (excluding Quebec) were admitted to hospital for clinical stroke syndrome. Median age was 75 (interquartile range [IQR] 64-84) years; 50.6 % were male. Less than 5% (n=4030) of patients were transferred. Patients transferred to stroke centers were younger (p<0.001) and had shorter median length of stay (p<0.001). The highest probability of discharge home was associated with sole care at stroke center (43.8%). Transfer to stroke center from community hospital had the highest probability for discharge to rehabilitation facility (25%) and lowest to either long-term (2.1%) or complex community care (2.0%). Transferred patients had lower mortality at discharge. CONCLUSION Younger patients were transferred more frequently to stroke centers; older patients were more likely treated in community hospitals. Sole stroke center care was associated with high discharge rate to home; transfer to a stroke center was associated with high discharge rate to rehabilitation and lower mortality rates.
Collapse
|
4
|
Affiliation(s)
- David J. Werring
- From the Stroke Research Centre, Department of Brain Repair and Rehabilitation, UCL Institute of Neurology, National Hospital for Neurology and Neurosurgery, Queen Square, London, United Kingdom
| |
Collapse
|
5
|
Rudaks LI, Ahangar I, Dodd L, Milton AG, Hamilton-Bruce MA, Jannes J, Koblar SA. Endovascular treatment for acute ischemic stroke: experience in South Australia. Int J Stroke 2015. [PMID: 26202716 DOI: 10.1111/ijs.12580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Laura Ivete Rudaks
- Stroke Research Programme, Discipline of Medicine, University of Adelaide, Adelaide, SA, Australia
| | - Idin Ahangar
- Radiology Department, Geelong Hospital, Geelong, Vic., Australia
| | - Lizzie Dodd
- Stroke Unit, The Queen Elizabeth Hospital, Woodville, SA, Australia
| | - Austin Graham Milton
- Stroke Research Programme, The Queen Elizabeth Hospital, Woodville, SA, Australia
| | - Monica Anne Hamilton-Bruce
- Stroke Research Programme, Discipline of Medicine, University of Adelaide, Adelaide, SA, Australia.,Stroke Research Programme, Neurology Department, The Queen Elizabeth Hospital, Woodville, SA, Australia
| | - Jim Jannes
- Stroke Unit, The Queen Elizabeth Hospital, Woodville, SA, Australia
| | - Simon Andrea Koblar
- Stroke Research Programme, Discipline of Medicine, University of Adelaide, Adelaide, SA, Australia.,Stroke Research Programme, Neurology Department, The Queen Elizabeth Hospital, Woodville, SA, Australia
| |
Collapse
|