PracticeUpdate Cardiology March 2019

CONFERENCE COVERAGE 20

International Stroke Conference 2019 6–8 FEBRUARY 2019 • HONOLULU, HAWAII By the PracticeUpdate Editorial Team Target: Stroke Phase II Improves Door-to-Needle Times in Acute Ischemic Stroke Faster treatment linked with better clinical outcomes and a higher proportion of patients being eligible for thrombolysis therapy. T he American Heart Association’s Target: Stroke Program is effectively speeding up the time to treatment

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The proportion of patients with door-to- needle times ≤45 minutes improved from 17.7% in phase I to 40.0% in phase II, with an absolute difference of 22.3%, (P < .0001). The estimated annual increase in patients with door-to-needle times ≤45 minutes was 0.45% prior to Target: Stroke, 3.5% during phase I, and 6.5% during phase II (P < .0001). In addition, a greater proportion of eligible patients were treated with IV tPA. Rates of risk-adjusted in-hospital clinical outcomes, including in-hospital mortality, discharge home, ambulatory status inde- pendent, and symptomatic intracranial hemorrhage within 36 hours, all improved sequentially from the pre-Target: Stroke period through phase II. “This study shows that, across a very broad spectrum of hospitals across the US, achieving very fast treatment times is possible,” said Dr. Smith. “The American Heart Association will launch Target: Stroke phase III this spring, which for the first time will include goals for improving times to deployment of devices for endovascular thrombectomy in eligible patients.” www.practiceupdate.com/c/79803

downloadable reports on demand.” The second phase of the program, taking place from 2014 to present, specifically identified and disseminated additional best practice strategies, provided updated clin- ical decision support tools, and set new hospital recognition goals. Overall, 143,069 patients were treated with IV tPA at one of 901 participating hospitals. Rates of door-to-needle times of ≤60 and ≤45 minutes were compared among the pre-Target: Stroke period (2003–2009), phase I of the program (2010–2013), and phase II (2014–present). In 2018, 75% of patients received IV tPA within 60 minutes and 50% within 45 minutes. From phase I to phase II of the program, median door-to-needle time decreased from 66 minutes (interquar- tile range [IQR] 51–87) to 51 minutes (IQR 38–67). In addition, the proportion of patients with door-to-needle times ≤60 minutes increased from 42.7% to 67.7%, with an absolute difference of 25.0%, (P < .0001).

with the intravenous tissue plasminogen activator (IV tPA) alteplase among patients with acute ischemic stroke, according to an evaluation of phase II of the program. The Target: Stroke Program “is designed to help hospitals reduce their times to treat- ing patients with alteplase,” presenter Eric E. Smith, MD, of the University of Calgary in Canada, told Elsevier’s PracticeUpdate . “Participating hospitals receive public recognition for fast treatment times. To help them achieve better times, we dis- seminate information on good practices for faster treatment via webinars, sharing care pathways, and distributing consensus recommendations. Most hospitals partic- ipate in the American Heart Association Get With The Guidelines Stroke Program, a hospital quality improvement program that allows them to upload their data on treatment times and receive customizable

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