Abstract
ObjectivesThere is a paucity of data on the risk of nursing home admission or domiciliary care initiation according to time to intravenous thrombolysis for ischemic stroke. We investigated the association between time to intravenous thrombolysis and the composite of nursing home admission or domiciliary care initiation in patients with acute ischemic stroke. Materials and MethodsIn this nationwide cohort study, all stroke patients treated with intravenous thrombolysis (2011–2015) and alive at discharge were identified from the Danish Stroke Registry and other nationwide registries. The composite of nursing home admission or domiciliary care initiation one year post-discharge according to time to thrombolysis was examined with multivariable Cox regression. ResultsThe study population comprised 4,349 patients (median age 67 years [25th-75th percentile 57–75], 65.2% men). The median National Institutes of Health Stroke Scale score at presentation was 5, and the median time from symptom-onset to initiation of thrombolysis was 143 min. The absolute 1-year risk of the composite endpoint was 14.0% (95%CI, 11.5–16.8%) in the ≤90 min group, 16.6% (15.1–18.1%) in the 91–180min group, and 16.0% (14.0–18.2%) in the 181–270 min group. Compared with thrombolysis ≤90 min, time to thrombolysis between 91–180 min and 181–270 min was associated with a significantly higher risk of the composite endpoint (hazard ratio 1.31 [1.04–1.65] and 1.47 [1.14–1.91], respectively). ConclusionsIn patients admitted with ischemic stroke, increasing time to thrombolysis was associated with a greater risk of the composite of nursing home admission or domiciliary care initiation. Continued efforts to shorten the time delay from symptom-onset to initiation of thrombolysis are warranted.
Highlights
In patients with acute ischemic stroke, thrombolytic therapy with intravenous recombinant tissue-type plasminogen activator within 270min after symptom-onset is a medical treatment known to improve outcomes.3À6 It is well-established that treatment delay decreases the beneficial effect of thrombolytic therapy and international guidelines for the management of acute ischemic stroke recommend this treatment to be initiated in eligible patients without any delay.3À8 these recommendations are derived from data from older studies, and outcome assessment has primarily focused on traditional clinical outcomes such as mortality, degree of disability, and functional independence
In this nationwide cohort study, we examined the risk of nursing home admission and domiciliary care initiation among all Danish residents admitted with acute ischemic stroke according to time to intravenous thrombolysis
Time to thrombolysis between 91À180 min and 181À270 min was associated with a significantly increased risk of the composite of nursing home admission or domiciliary care initiation compared with thrombolysis received 90 min
Summary
Stroke is a leading cause of death and acquired disability worldwide.[1,2] In patients with acute ischemic stroke, thrombolytic therapy with intravenous recombinant tissue-type plasminogen activator within 270min after symptom-onset is a medical treatment known to improve outcomes.3À6 It is well-established that treatment delay decreases the beneficial effect of thrombolytic therapy and international guidelines for the management of acute ischemic stroke recommend this treatment to be initiated in eligible patients without any delay.3À8 these recommendations are derived from data from older studies, and outcome assessment has primarily focused on traditional clinical outcomes such as mortality, degree of disability, and functional independence. The need for domiciliary support or admission to a nursing home represents a substantial economic burden on society, and carries significant personal implications for the individual, including loss of independence and self-esteem, loneliness, and potentially depression and other mental health problems.[9,10] there is a paucity of data on the risk of nursing home admission and domiciliary care initiation according to time to thrombolytic therapy Evaluation of such outcomes may help to identify patients who are at high risk of poor outcomes, and provide novel insights on the importance of time to initiation of intravenous thrombolytic therapy on post-discharge 1-year outcomes. We examined the risk and factors associated with nursing home admission and domiciliary care initiation in a large nationwide cohort of patients with acute ischemic stroke according to time to thrombolysis
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