Abstract Details

Title Independent Predictors of IV tPA Use in the Partners Telestroke Network: A Multistate, Multicenter Hospital Alliance in the Remote Management of Acute Ischemic Stroke

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) P05 - (-)

Poster/Presentation
Number 222

Objective

Background BACKGROUND: Telestroke (TS) systems link rural and under-resourced spoke hospitals to regional acute stroke center hubs to provide regionalized acute stroke care. The PTN consists of five regional US hubs serving 56 spokes.

Design/Methods DESIGN/METHODS: The PTN is run by Partners Healthcare with hubs in MA, CT, WA, OK and VA. We analyzed clinical characteristics of all 2205 patients entered into the PTN common data portal and diagnosed with AIS from 01/2008-08/2012 (MA, n=1692; OK, n=252; CT, n=171; WA, n=56; VA, n=34). Multivariate models were built to identify predictors of tPA use including patient characteristics and network hub designation.

Results RESULTS: Overall, the PTN AIS patients were median 72.0 years of age, 50.5% female and of varying race (78.4% white, 2.8% Black, 18.8% others). Rates of hypertension were 55.8%; prior stroke, 25.7%; hyperlipidemia, 20.2%; coronary disease, 18.2%; diabetes, 18.8%; atrial fibrillation, 19.8%; and smoking 7.2%. There was significant variation in age, race, gender and vascular risk factors in the populations served by the 5 hubs. IV tPA was provided to 767 (34.8%) patients overall (range 20%-45% per hub; p<0.001). Median last known well (LKW) to IV tPA times ranged from 131 min - 144 min across the cohort. The only independent predictors of IV tPA use were prior stroke [OR 1.47 (95% CI 1.12 - 1.93); p=0.006] and higher NIHSS [OR 1.15 per point (1.13 - 1.18); p<0.001].

Conclusions CONCLUSIONS: Despite variability across patient characteristics and frequency of tPA use by site, only prior stroke and stroke severity, and not hub site, predicted IV tPA use across the network. These data suggest that TeleStroke networks are generalizable and produce high rates of tPA use.

Authors/Disclosures
Lee H. Schwamm, MD, FAAN (Yale New Haven Health System) PRESENTER	Dr. Schwamm has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Prime ��ɫ��. Dr. Schwamm has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Genentech. Dr. Schwamm has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for lifeimage. Dr. Schwamm has received personal compensation in the range of $500-$4,999 for serving as a Consultant for mediasphere. Dr. Schwamm has received personal compensation in the range of $500-$4,999 for serving as a Consultant for medscape/WebMD. Dr. Schwamm has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for medtronic. Dr. Schwamm has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Penumbra. Dr. Schwamm has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Genentech. The institution of Dr. Schwamm has received research support from NINDS. The institution of Dr. Schwamm has received research support from PCORI. Dr. Schwamm has received intellectual property interests from a discovery or technology relating to health care. An immediate family member of Dr. Schwamm has received publishing royalties from a publication relating to health care. Dr. Schwamm has a non-compensated relationship as a Board of directors with American heart association that is relevant to AAN interests or activities.
Syed T. Ali, MBBS, BSc, MD (Syed T Ali MD PLLC)	No disclosure on file
Lawrence W. Davis, MD (Lawrence W. Davis, MD Inc)	No disclosure on file
	No disclosure on file
	No disclosure on file
Greg Mytyk (University of Tennessee)	No disclosure on file
Joseph L. Schindler, MD (Yale University Department of Neurology)	Dr. Schindler has received personal compensation for serving as an employee of Aeromics. Dr. Schindler has received personal compensation in the range of $50,000-$99,999 for serving as an officer or member of the Board of Directors for Aeromics. Dr. Schindler has received stock or an ownership interest from Aeromics. Dr. Schindler has received publishing royalties from a publication relating to health care.
	No disclosure on file
William H. Likosky, MD, FAAN	No disclosure on file
Nina J. Solenski, MD (UVA - Neurology)	Dr. Solenski has received personal compensation in the range of $0-$499 for serving as an Expert Witness for Multiple. The institution of Dr. Solenski has received research support from HRSA . Dr. Solenski has received intellectual property interests from a discovery or technology relating to health care.
	No disclosure on file
	No disclosure on file

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