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. 2022 Mar 4:13:827965.
doi: 10.3389/fneur.2022.827965. eCollection 2022.

Lessons Learned From the Historical Trends on Thrombolysis Use for Acute Ischemic Stroke Among Medicare Beneficiaries in the United States

Tong Meng  1   2 , Amber W Trickey  2 , Alex H S Harris  2   3 , Loretta Matheson  1 , Sarah Rosenthal  1 , Abd Al-Rahman Traboulsi  4 , Jeffrey L Saver  5 , Todd Wagner  2   3 , Prasanthi Govindarajan  1   2
Affiliations

Lessons Learned From the Historical Trends on Thrombolysis Use for Acute Ischemic Stroke Among Medicare Beneficiaries in the United States

Tong Meng et al. Front Neurol. .

Abstract

Background: The most recent time trends on intravenous thrombolysis (IVT) utilization for acute ischemic stroke was reported in 2011 using the Get with the Guidelines. Our objectives are to assess and validate the change in IVT utilization through 2014 in a national sample of Medicare beneficiaries and to examine the effect of patient, stroke center designation, and geography on IVT utilization.

Methods: We built a comprehensive national stroke registry by combining patient-level, stroke center status, and geographical characteristics, using multiple data sources. Using multiple national administrative databases from 2007 to 2014, we generated a mixed-effect logistic regression model to characterize the independent associations of patient, hospital, and geographical characteristics with IVT in 2014.

Results: Use of IVT increased consistently from 2.8% in 2007 to 7.7% in 2014, P < 0.001. Between group differences persisted, with lower odds of use in patients who were ≥86 years (aOR 0.74, 95% CI 0.65-0.83), Black (aOR 0.73, 95% CI 0.61-0.87), or treated at a rural hospital (aOR 0.88, 95% CI 0.77-1.00). Higher odds of use were observed in patients who arrived by ambulance (aOR 2.67, 95% CI 2.38-3.00), were treated at a hospital certified as a stroke center (aOR 1.96, 95% CI 1.68-2.29), or were treated at hospitals located in the most socioeconomically advantaged areas (aOR 1.27, 95% CI 1.05-1.54).

Conclusions: Between 2007 and 2014, the frequency of IVT for patients with acute ischemic stroke increased substantially, though differences persisted in the form of less frequent treatment associated with certain characteristics. These findings can inform ongoing efforts to optimize the delivery of IVT to all AIS patients nationwide.

Keywords: acute ischemic stroke; disparities of care; intravenous thrombolysis; stroke registry; temporal trends.

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Conflict of interest statement

JS is an employee of the University of California. The University of California has patent rights in retrieval devices for stroke. The University of California Regents received payments on the basis of clinical trial contracts for the number of subjects enrolled in multicenter clinical trials sponsored by Medtronic, Stryker, Cerenovus, BrainsGate, and Boehringer Ingelheim (prevention only); JS served as an unpaid site investigator under these contracts. JS serves as an unpaid consultant to Genentech advising on the design and conduct of the PRISMS trial; neither the University of California nor JS received any payments for this voluntary service. JS paid for his own travel. JS has received contracted hourly payments and travel reimbursement for services as a scientific consultant advising on rigorous trial design and conduct to Medtronic, Stryker, Cerenovus, BrainsGate, Boehringer Ingelheim (prevention only), Diffusion Medical, and Abbott. JS has received contracted stock options for services as a scientific consultant advising on rigorous trial design and conduct to Rapid Medical. JS has not participated as a medicolegal expert in any litigation regarding acute stroke management. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Temporal trend from 2007 to 2014 in IVT use in a national sample of medicare patients hospitalized for acute ischemic stroke.
See this image and copyright information in PMC

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