Abstract T P318: Comparative Effectiveness of tPA on 6 Month, Patient-Centered Outcomes: A Pilot Analysis

Abstract

We examined the real-world benefit of tPA, delivered as part of usual care, on patient-centered outcomes. All persons with a diagnosis of stroke or TIA from our hospital are contacted for telephone follow-up at 6 mos. after the event. The survey includes the Stroke Impact Scale (SIS), Patient Health Questionnare-9 (PHQ9), and other questions about aspects of daily life. This study retrospectively compared outcomes in patients who received tPA as part of usual care with patients who would have received tPA had they arrived at the hospital within the time window, i.e. criteria other than time were met. From hospital records, we acquired demographic and medical data. Patients in each group with completed surveys were matched on initial NIHSS score, age, race, gender, and date of stroke. Staff conducting surveys were independent from staff determining matches and were blinded to the others data. Matching was done with 1:2 ratio of tPA to controls. Results were compared between groups with 1-tailed tests due to directionally-specific hypothesis in favor of the tPA group. Persons receiving tPA and controls completed the surveys at the same rate. Sample size was 67 for the tPA group and 137 for the control group, with the groups matched across the above variables as intended. On the SIS, the tPA group reported better physical function (p=.001), communication (p=.048), cognition (p=.029), and quality of life (p=.04) compared to the control group. Depressive symptomatology, as indicated by PHQ9 scores, was not different between groups (p=.48). Fewer people in the tPA group (27%) reported 1 or more emergency room visits in the 6 months after their stroke compared to controls (44%, p=.03). Of those driving prior to their stroke, 72% had returned to driving, vs. 58% of controls (p=.045). Return to work rates were not different (52% tPA vs. 39% controls, p=.19) within the smaller subset of people working prior to their stroke. While it is known that tPA reduces long-term disability, this is the first study to demonstrate the effectiveness of tPA in improving meaningful, patient-centered outcomes, such as physical function and communication. These data indicate that use of tPA provides a large benefit to the daily lives of people with ischemic stroke.