This article is more than 5 years old. Information may no longer be current.
Each 15-minute delay in stroke treatment linked to month loss of healthy life
A few minutes saved in the delivery of stroke thrombolysis may translate to significant benefits equivalent to days, weeks or even months of disability-free life over a lifetime for patients with stroke, according to a new report.
Prospective data from US stroke centers indicate that each 15-minute decrease in stroke treatment delay provided a mean equivalent of 1 month of additional disability-free life.
These findings suggest that “realistically achievable small reductions in stroke thrombolysis delays would result in significant and robust average health benefits over patients’ lifetimes,” researchers wrote. “The awareness of concrete importance of speed could promote practice change.”
Previous research demonstrated that stroke thrombolysis is most effective within 1.5 hours of symptom onset and remains effective up to 4.5 hours after onset. However, data on long-term effects from small reductions in treatment delays were unavailable, according to the study background. Median door-to-needle times are as fast as 20 minutes at the best practice centers, but the median door-to-needle time at American, Australian and European centers is 70 to 80 minutes, the researchers wrote.
Researchers studied stroke patients (n=2,258) treated with IV tissue plasminogen activator (tPA) at Australian and Finnish centers from 1998 to 2011. Their analysis produced ORs by onset-to-treatment time for favorable outcome (modified Rankin Scale score of 0 or 1) and mortality (modified Rankin Scale score of 6) of tPA compared with placebo. Those data were used to model how a change in onset-to-treatment time affects the probability of favorable outcome or mortality. To quantify long-term outcomes, the researchers used disability-adjusted life-years lost, which measures years of life lost due to premature death and years of life lost due to disability.
Time saved led to better outcomes
Each minute of onset-to-treatment time saved garnered a mean of 1.8 days (interquartile range, 1.1-2.3) of extra healthy life (95% prediction interval, 0.9-2.7).
Gains in disability-free life from savings in onset-to-treatment time occurred in all subgroups:
- In older patients (aged 80 years) with severe stroke (NIH Stroke Scale score, 20), each minute saved was linked to 0.6 days of extra healthy life.
- In older patients with mild stroke (NIH Stroke Scale score, 4), each minute saved was linked to 0.9 days of extra healthy life.
- In younger patients (aged 50 years) with mild stroke (NIH Stroke Scale score, 4), each minute saved was linked to 2.7 days of extra healthy life.
- In younger patients with severe stroke (NIH Stroke Scale score, 20), each minute saved was linked to 3.5 days of extra healthy life.
The greatest gains were achieved by the youngest patients with the longest life expectancies after stroke, and women achieved slightly more gains than men.
Results generalizable
“It is likely that our results can be generalized to other populations with similar demographics and treatment practices, in keeping with comparisons of tPA vs. no tPA,” Atte Meretoja, MD, from the University of Melbourne, and colleagues wrote. “Our results can also be translated to populations with different onset-to-treatment times, because the marginal effect on [disability-adjusted life years] gained is stable in the tPA time window and to patients of different age and stroke severity.”
Disclosure: See the full study of a list of the researchers’ relevant financial disclosures.