Effect of stroke screening survey on intravenous thrombolysis and long-term outcomes in acute ischemic stroke patients: the real-world evidence from Shanghai, China

Fen Li; Yuqian Chen; Lan Hong; Bifan Zhu; Duo Chen; Xinyu Qin; Guangfeng Gao; Jianhua Xu; Xin Cheng; Qiang Dong; Chunlin Jin; Kun Fang

doi:10.21037/atm-21-1971

Effect of stroke screening survey on intravenous thrombolysis and long-term outcomes in acute ischemic stroke patients: the real-world evidence from Shanghai, China

Ann Transl Med. 2021 Sep;9(17):1363. doi: 10.21037/atm-21-1971.

Authors

Fen Li¹, Yuqian Chen¹, Lan Hong², Bifan Zhu¹, Duo Chen¹, Xinyu Qin¹, Guangfeng Gao³, Jianhua Xu⁴, Xin Cheng², Qiang Dong^{2

5

6}, Chunlin Jin¹, Kun Fang^{2

5

6}

Affiliations

¹ Department of Health Policy Research, Shanghai Health Development Research Center, Shanghai, China.
² Department of Neurology, Huashan Hospital Affiliated to Fudan University, Shanghai, China.
³ Jiading Information Center for Health, Shanghai, China.
⁴ Department of Neurology, Jiading Central Hospital Affiliated to Shanghai University of Medicine and Health Science, Shanghai, China.
⁵ National Center for Neurological Disorders, Shanghai, China.
⁶ Shanghai Stroke Service Center, Shanghai, China.

Abstract

Background: The stroke screening survey (SSS) is an essential strategy for stroke prevention. However, previous studies rarely discussed the effect of SSS on the acute phase treatment procedure for acute ischemic stroke (AIS) and the long-term prognosis outcomes. This study aims to investigate the effect of SSS on intravenous thrombolysis and long-term outcomes in AIS patients.

Methods: The stroke patients included were collected from Jiading Residences Community Health Records and Shanghai Stroke Service System database, from January 2017 to December 2019. Patients were divided into two groups, according to whether they have been screened before the event (onset and death). Demographic characteristics and treatment information of patients in the two groups were compared by the Mann-Whitney test and Chi-square test. The demographic differences between groups were adjusted with Propensity Score Matching (PSM) to evaluate the effect of SSS on door-to-needle time (DNT). The Kaplan-Meier survival curve with a log-rank test and multiple Cox regression model were used to evaluate the effect of SSS on long-term lifetime.

Results: A total of 1,236 patients with AIS were collected, including 468 (37.86%) female, 126 (10.19%) patients with intravenous thrombolysis, 241 (23.30%) patients died from all-cause mortality by January 8, 2020. A total of 124 (10.03%) patients have been screened before AIS onset, and 261 (21.17%) patients had undergone SSS after AIS onset. The baseline information indicated that patients with previous screening were older than the patients without at the time of onset [75 (70, 83) vs. 73 (65, 82), P=0.017], as well as more likely to have a history of hypertension (90.32% vs. 78.51%, P=0.002) and diabetes (50.00% vs. 25.81%, P<0.001). PSM results showed that patients with previous screening were associated with less severe onset situation [3 (1, 9) vs. 3 (1, 5), P=0.001] and shorter DNT [30 (24, 49) vs. 44 (31.5, 49), P=0.037] when compared to patients without. Additionally, patients with SSS had a lower hazard ratio of 0.567 (95% CI: 0.380-0.847, P=0.006) on all-cause mortality.

Conclusions: For AIS patients, the SSS is associated with less severe onset situation, shorter DNT, and longer long-term lifetime.

Keywords: Acute ischemic stroke (AIS); door-to-needle time (DNT); intravenous thrombolysis; stroke screening survey (SSS); survival analysis.