Abstract
BackgroundRates of thrombolysis in most countries are well below best practice benchmarks. We aimed to investigate thrombolysis utilization and its associated factors in acute ischemic stroke (AIS) patients in Hubei province, China, to assess neurologists’ experiences of the treatment, and to identify barriers against the treatment from perspective of AIS patients and neurologists.MethodsSurvey of 2096 AIS patients and 709 neurologists from 66 hospitals was conducted in Hubei province between 2014 and 2015. A multivariable logistic regression model was utilized to identify the factors associated with thrombolysis utilization and neurologists’ experiences with thrombolysis.ResultsOf the 2096 AIS patients, only 3.8% received thrombolysis. Of the 709 neurologists, 66.0% reported using thrombolysis for AIS patients. The main reasons for not using thrombolysis were late arrival of patients, fear of the risk of complications of thrombolysis, and light or quickly recovered stroke symptoms. The behavior and clinical characteristics of patients, including early admission to hospital (odds ratio [OR] = 5.81, 95% confidence intervals [CI] 3.31–10.20), using emergency medical services to be hospitalized (OR = 3.36, 95% CI 2.00–5.62), stroke history (OR = 0.53, 95% CI 0.28–0.99), and National Institute of Health Stroke Scale score < 4 (OR = 0.46, 95% CI 0.27–0.77) were shown to significantly affect the thrombolysis utilization in the multivariate model. In addition, hospital grade (OR = 2.84, 95% CI 1.84–4.37), education level (OR = 2.49, 95% CI 1.09–5.73), and working years (OR = 1.88, 95% CI 1.18–3.00) were strongly associated with neurologists’ experiences of thrombolysis.ConclusionsA very low proportion of AIS patients received thrombolysis in Hubei province, China. Considerable education programs and interventions were required regarding knowledge of stroke treatment for clinicians and proper behavior after stroke for AIS patients and their families.
Highlights
Rates of thrombolysis in most countries are well below best practice benchmarks
Patients who were young, who were male, who had higher education experiences, who admitted to hospital by emergency medical services (EMS), whose National Institutes of Health Stroke Scale (NIHSS) score ≥ 4, and who admitted to hospital in 3 h after the symptoms onset had higher rates of thromblysis
The major strength of our study is that we explore the experiences and evaluation of thrombolysis, as well as the reasons for not giving thrombolysis in both neurologists and patients, which can offer scientific basis for the efficient emergency treatment of stroke and help to increase intravenous Recombinant Tissue-type Plasminogen Activator (rt-PA) use in China
Summary
Rates of thrombolysis in most countries are well below best practice benchmarks. We aimed to investigate thrombolysis utilization and its associated factors in acute ischemic stroke (AIS) patients in Hubei province, China, to assess neurologists’ experiences of the treatment, and to identify barriers against the treatment from perspective of AIS patients and neurologists. Combined with the data of China National Stroke Registry (from September 2007 to August 2008) and China Quality Evaluation of Stroke Care and Treatment project (from July 2007 to November 2007), only approximately 1.2– 1.9% of AIS patients are treated with rt-PA [14]. Another studies carried out in 7 cities of China in 2006 have showed that 2.7% of AIS patients received thrombolytic therapy [15], whose rates are lower than developed countries. It is of great significance to explore reasons for low thrombolysis rate in developing countries
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