Hospitals Improve Acute Ischemic Stroke Outcomes by Implementing New Guidelines

According to a study presented at the AHA/ASA International Stroke Conference 2019, hospitals utilizing the Target: Stroke Phase II strategies were able to decrease door-to-needle (DTN) time from 66 minutes to 51 minutes. 

“The Target: Stroke program helps hospitals identify best practice strategies, utilize clinical decision tools, and guidelines for patient care. Research analyzing data from this program supports the conclusion that quality improvement measures
from Target: Stroke result in substantial improvement in patient care and outcomes,” according to program’s web page. 

Researchers also presented in their findings that there were significant improvements in time to alteplase administration in the “Get with the Guidelines-Stroke: hospitals after implementing the AHA/ASA Target Stroke Phase II. 

“It is a common saying in the stroke community—time is brain—but it is entirely true,” said Gregg C. Fonarow, MD, director of the Ahmanson-UCLA Cardiomyopathy Center, co-chief of UCLA’s Division of Cardiology and professor of cardiovascular medicine, UCLA, Los Angeles, CA, lead author of the study and volunteer expert for the American Heart Association.  “Every minute a stroke goes untreated a typical patient loses 1.9 million neurons—so a faster response time is critical to improved patient outcomes.”

In addition to sharing the positive result from phase II, researchers introduced Target: Stroke Phase III of the program. “Phase III of this American Heart Association/American Stroke Association initiative further raises the bar by setting more aggressive targets for timely treatment with [intravenous]alteplase,” said Dr Fonarow. “But now the aim goes beyond faster door-to-needle times. Phase III introduces a second type of intervention into the mix, setting the first-ever targets for prompt treatment with endovascular therapy.”

The phase III portion will continue to improve upon DTN times in addition to setting new goals for patients treated with IV thrombolytics. According to the AHA/ASA website, “The primary goals for Target: Stroke Phase III are: (1) Achieve DTN times within 60 minutes in 85% or more of acute ischemic stroke patients treated with IV thrombolytics and (2) Achieve door-to-device times (arrival to first pass with thrombectomy device) within 90 minutes for direct-arriving patients and within 60 minutes for transfer patients in 50% or more of acute ischemic stroke patients treated with endovascular therapy.—Edan Stanley