Abstract Details

Title Outcome Assessment of Acute Ischemic Stroke Patients after Treatment with IV tPA in a Rural Health System

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) P02 - (-)

Poster/Presentation
Number 026

Objective

Background BACKGROUND: Unique challenges exist for treatment of acute ischemic stroke in rural populations. Longer time for travel to a medical facility and limited experience with stroke and IV tPA by rural providers raises concerns about the safety of administration and outcomes for patients.

Design/Methods DESIGN/METHODS: We conducted a retrospective review of the electronic health records of patients treated with IV tPA for acute stroke in a rural health system hospital from 2006 to 2012. Patients were included in the study if they had 90-day follow-up or died within 90 days. Health history and in-hospital events were recorded. The primary outcome measure was the percentage of patients with favorable outcomes (defined as having modified Rankin Scale [mRS] score of ?1) compared with that reported in the pivotal NINDS clinical trial that led to approval of IV tPA. Secondary outcome measures included rates of intracranial hemorrhage and prior medical history associated with poor outcome at 90 days (defined as mRS score of >1).

Results RESULTS: Twenty-eight patients were included in the analysis. Of the patients in the rural group, 35.71% had favorable outcomes at 90 days, compared with 38.69% in the historical control group (p=0.764). Rural and historical control group rates of symptomatic intracranial hemorrhage were not statistically different (17.86% vs 7.14%; p=0.0742). Patients who experienced fewer in-hospital complications also had more favorable outcomes (72.73% vs 27.27%; p<0.002). Compared with controls, significantly fewer rural patients received IV tPA within 90 minutes of symptom onset (3.57% vs 96.43%; p<1.0[times]10-6).

Conclusions CONCLUSIONS: Patients administered IV tPA for acute ischemic stroke in a rural hospital setting experienced 90-day outcomes similar to those of historical controls. Further attempts to reduce the number of in-hospital complications and reduce time to administration may result in improved patient outcomes.

Authors/Disclosures
PRESENTER	No disclosure on file
Jason L. Aldred, MD, FAAN (Selkirk Neurology)	Dr. Aldred has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Boston Scientific. Dr. Aldred has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Abbvie. Dr. Aldred has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Allergan . Dr. Aldred has received personal compensation in the range of $0-$499 for serving as a Consultant for Quadralynx. Dr. Aldred has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Abbvie. Dr. Aldred has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Boston Scientific. Dr. Aldred has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Medtronic. Dr. Aldred has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for Abbvie. Dr. Aldred has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Acorda. Dr. Aldred has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for Allergan. Dr. Aldred has received personal compensation in the range of $5,000-$9,999 for serving on a Speakers Bureau for Boston Scientific. Dr. Aldred has received personal compensation in the range of $100,000-$499,999 for serving on a Speakers Bureau for TEVA. Dr. Aldred has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Medtronic. Dr. Aldred has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for US World Meds. Dr. Aldred has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Kyowa Kirin. Dr. Aldred has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for Sunovion. Dr. Aldred has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Amneal. Dr. Aldred has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Biogen. Dr. Aldred has received personal compensation in the range of $50,000-$99,999 for serving as an Expert Witness for Arete Neuroscience, PLLC. The institution of Dr. Aldred has received research support from Biogen . The institution of Dr. Aldred has received research support from Abbvie. The institution of Dr. Aldred has received research support from Merz. The institution of Dr. Aldred has received research support from AstraZeneca. The institution of Dr. Aldred has received research support from Neurocrine. The institution of Dr. Aldred has received research support from Aptinyx. The institution of Dr. Aldred has received research support from Cerevance. The institution of Dr. Aldred has received research support from Boston Scientific . The institution of Dr. Aldred has received research support from Parkinson Foundation . The institution of Dr. Aldred has received research support from Roche. The institution of Dr. Aldred has received research support from Sage Therapeutics. The institution of Dr. Aldred has received research support from Annovis. The institution of Dr. Aldred has received research support from Biovie. The institution of Dr. Aldred has received research support from NeuroDerm. The institution of Dr. Aldred has received research support from PhotoPharma. The institution of Dr. Aldred has received research support from Lilly.
	No disclosure on file
	No disclosure on file

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