Starting treatment for stroke patients 15 minutes faster could save lives and prevent disability, according to a UCLA-led study that also determined that the outcome was better for people treated at hospitals that handle more than 450 stroke cases annually.
Researchers at the David Geffen School of Medicine at UCLA and five other institutions in the U.S. and Canada, examined data for 6,756 people who experienced ischemic strokes. The patients’ median age was 71, and 51.2% were women.
According to UCLA, the researchers looked at stroke patients’ treatment results in light of their “door-to-puncture” time — the interval from their arrival at the hospital to the time their treatment began.
They found that for every 1,000 people whose door-to-puncture time was 15 minutes sooner, 15 fewer died or were discharged to hospice care, 17 more were able to walk out of the hospital without assistance and 22 more could care for themselves after being discharged from the hospital.
The patients’ median time from arriving at the hospital to the beginning of treatment was nearly an hour and a half, and the median time from the onset of symptoms to treatment was three hours, 50 minutes.
All of the patients in the study, which was published this week in JAMA: The Journal of the American Medical Association, were treated with endovascular reperfusion therapy, which is used to treat strokes caused by a blockage in one of the major arteries of the brain.
Dr. Reza Jahan, the study’s co-lead author and a professor of interventional neuroradiology at the Geffen School of Medicine, said that based on the results, shaving 15 minutes off of treatment time could potentially improve outcomes for thousands of stroke patients annually.
The researchers found that hospitals that perform endovascular reperfusion therapy on more than 50 patients per year generally begin treatment faster than hospitals that perform fewer than 30; and that initial treatment tends to be delayed at hospitals that are not certified as comprehensive stroke centers or are located in the Northeast, as well as for people who have a stroke during hospital “off hours” — weekends, holidays, and before 7 a.m. and after 6 p.m. on weekdays.
“We’re trying to improve treatment with better staffing on off hours and getting doctors to the hospital quicker when they’re on call,” Jahan said. “Patients who arrive at the hospital at 2 a.m. should be treated no differently than people who arrive at 2 p.m.”
Based on the study results, the American Heart Association has published new goals regarding how fast patients should be treated at comprehensive stroke centers, according to Jahan, who noted that treatment delays are more likely for people who live alone or fail to recognize their own stroke symptoms.
About 795,000 people in the U.S. have strokes each year, and about 140,000 die as a result. Ischemic strokes, which occur when a vessel supplying blood to the brain is obstructed, account for 87% of all strokes. Other types of strokes include hemorrhagic strokes and transient ischemic attacks, which are sometimes referred to as mini strokes.
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