https://www.healio.com/cardiology/stroke/news/online/%7B845cb641-2220-4017-9fa6-da6fe8d7c89e%7D/telemedicine-decreases-time-to-alteplase-administration-for-stroke?utm_source=selligent&utm_medium=email&utm_campaign=cardiology%20news&m_bt=592835816269
A novel telemedicine
program increased alteplase administration rates and shortened
door-to-needle times without an increase in adverse outcomes, according
to a study published in Stroke.
“When a stroke happens, minutes matter,” Mai Nguyen-Huynh, MD, MAS, vascular neurologist and research scientist in the division of research at Kaiser Permanente in Oakland, California, said in a press release. “Faster treatment with intravenous [alteplase], which dissolves the stroke-causing clot and restores blood flow to the brain, is strongly associated with better functional outcomes for stroke patients.”
Researchers analyzed data from 310 patients (mean age, 71 years; 50%
women) who received alteplase (Activase, Genentech) before the telemedicine program
was implemented and 557 patients (mean age, 74 years; 53% women) who
received it after the program was initiated in 21 Kaiser Permanente
Northern California hospitals.
The telemedicine program included ambulance prenotification, neurological evaluation, medical history review from electronic medical records, notification of potential transfer for endovascular stroke treatment, alteplase administration in the CT suite and rapid transport to the suite. A teleneurologist was on-call to examine and monitor the patient.
The primary outcome was the door-to-needle time for the administration of alteplase. Secondary outcomes were symptomatic intracranial hemorrhage, rate of alteplase administrations per month and disposition at discharge.
Alteplase administrations increased from 34 per month before implementation to 62 per month once the program was in place (P < .001). Door-to-needle times decreased from 52 minutes to 34 minutes (P < .001).
Alteplase administration times of less than 60 minutes occurred in 87.1% of patients during the program vs. 61% before it was implemented (P < .001). Patients who were treated within 30 minutes increased from 4.2% before the program was initiated to 40.8% after the program started (P < .001).
The rate of symptomatic intracranial hemorrhage was similar before (2.2%) and after (3.8%) the program was in place (P = .29).
“Future studies are needed to better evaluate the long-term sustainability of the intervention and its effect on clinical outcomes, including mortality and long-term disability,” Nguyen-Huynh and colleagues wrote. – by Darlene Dobkowski
Disclosures: The study was funded by the Permanente Medical Group. Nguyen-Huynh reports she received funding from the Permanente Medical Group.
“When a stroke happens, minutes matter,” Mai Nguyen-Huynh, MD, MAS, vascular neurologist and research scientist in the division of research at Kaiser Permanente in Oakland, California, said in a press release. “Faster treatment with intravenous [alteplase], which dissolves the stroke-causing clot and restores blood flow to the brain, is strongly associated with better functional outcomes for stroke patients.”
The telemedicine program included ambulance prenotification, neurological evaluation, medical history review from electronic medical records, notification of potential transfer for endovascular stroke treatment, alteplase administration in the CT suite and rapid transport to the suite. A teleneurologist was on-call to examine and monitor the patient.
The primary outcome was the door-to-needle time for the administration of alteplase. Secondary outcomes were symptomatic intracranial hemorrhage, rate of alteplase administrations per month and disposition at discharge.
Alteplase administrations increased from 34 per month before implementation to 62 per month once the program was in place (P < .001). Door-to-needle times decreased from 52 minutes to 34 minutes (P < .001).
Alteplase administration times of less than 60 minutes occurred in 87.1% of patients during the program vs. 61% before it was implemented (P < .001). Patients who were treated within 30 minutes increased from 4.2% before the program was initiated to 40.8% after the program started (P < .001).
The rate of symptomatic intracranial hemorrhage was similar before (2.2%) and after (3.8%) the program was in place (P = .29).
“Future studies are needed to better evaluate the long-term sustainability of the intervention and its effect on clinical outcomes, including mortality and long-term disability,” Nguyen-Huynh and colleagues wrote. – by Darlene Dobkowski
Disclosures: The study was funded by the Permanente Medical Group. Nguyen-Huynh reports she received funding from the Permanente Medical Group.
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