Quality initiative improves thrombolysis frequency, timeliness

The U.S. nationwide quality initiative Target: Stroke (TS) is associated with improvement in thrombolysis frequency, timeliness, and outcome, according to a study published online Feb. 7 in JAMA Network Open.

Shumei Man, M.D., Ph.D., from the Cleveland Clinic, and colleagues conducted a retrospective cohort study involving patients who presented within 4.5 hours of ischemic stroke onset to examine whether the TS quality initiative was associated with improvement in thrombolysis metrics and outcomes across racial and ethnic groups. The analyses included 1,189,234 patients; 1,053,539 arrived at the hospital within 4.5 hours.

The researchers found that in all racial and ethnic groups, the unadjusted thrombolysis rates increased in the pre-TS (2003 to 2009) and TS periods (phase I: 2010 to 2013; phase II: 2014 to 2018; phase III: 2019 to 2021), from 10 to 15 percent in 2003 to 43 to 46 percent in 2021. In adjusted analyses, disparities were seen and they persisted in TS phase III, with significantly lower odds of thrombolysis receipt for Asian, Black, and Hispanic versus White patients (adjusted odds ratios, 0.85, 0.76, and 0.86, respectively).

In all racial and ethnic groups, door-to-needle (DTN) times improved during TS; from 2009 to 2021, DTN times of 60 minutes or less increased from 26 to 28 percent to 66 to 72 percent. Racial and ethnic disparities were seen in adjusted analyses. Clinical outcomes improved for all racial and ethnic groups during TS.

"After adjustment for patient and hospital characteristics, Asian, Black, and Hispanic patients had lower odds of receiving thrombolysis and longer DTN times than White patients," the authors write.

Several authors disclosed ties to the pharmaceutical industry.

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