Abstract WP284: National Trends in Utilization and Outcomes of Thrombolytic Use by Drip and Ship Paradigm in Acute Ischemic Stroke Patients in United States

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Saqib A Chaudhry ◽  
Mohammad Rauf A Chaudhry ◽  
Mohsain Gill ◽  
Iqra N Akhtar ◽  
Adnan I Qureshi
Keyword(s):  
United States ◽  
Ischemic Stroke ◽  
Endovascular Treatment ◽  
Acute Ischemic Stroke ◽  
The United States ◽  
Severe Disability ◽  
Multivariate Logistic Regression Model ◽  
Thrombolytic Treatment ◽  
Stroke Patients ◽  
Hospital Outcomes

Background and Purpose: The drip and ship paradigm has rapidly expanded in the last decade allowing higher thrombolytic utilization and endovascular treatment. We performed this analysis to evaluate trends in utilization of drip and ship paradigm in United States and associated outcomes. Methods: We analyzed data for patients admitted with primary diagnosis of ischemic stroke in the United States from Nationwide Inpatient Sample, the largest nationally representative data, for the years 2009 to 2015. We studied changes in utilization of drip-and-ship paradigm and subsequent performance of endovascular treatment, and rates of discharge with none to minimal disability and moderate to severe disability. Results: Of the 3,043,190 patients admitted with ischemic stroke, 56,449 (1.85%) patients received thrombolytic treatment through drip-and-ship paradigm over a 7 year period. Of all patients who received thrombolytic treatment (n=243,824), 56,449 (23.15%) received using drip and ship paradigm. There was almost 3 fold increase in drip and ship paradigm (in 0.98% 2009 to 2.80% in 2015 (test for trend= p < 0.001). Among the patients who underwent drip and ship paradigm, 5,061 (8.97%) underwent endovascular treatment. The rate of endovascular treatment increased from 6.62% to 12.39% among patients treated with drip and ship paradigm (test for trend= p < 0.001). The rate of none minimal disability at discharge increased from 39.93% to 47.08%, (test for trend p < 0.001) while moderate to severe disability decreased 51.22% to 47.08%, (test for trend p < 0.001) in ischemic stroke patients treated using drip-and-ship paradigm. Similar trends were observed for hospital outcomes in multivariate logistic regression model, adjusted for age, gender, medical comorbidities and secondary intracranial hemorrhages. Conclusion: There has been a significant increase in the proportion of acute ischemic stroke patients treated using drip-and-ship paradigm (out of proportion to overall thrombolytic use) with increase in subsequent endovascular treatment in United States. The in hospital outcomes of patients have improved perhaps due to higher utilization of endovascular treatment.

Abstract 196: Thrombolytic Treatment using Drip and Ship Treatment Paradigm among Acute Ischemic Stroke Patients in the United States: Outcomes and impact on regional thrombolytic utilization and referral patterns

Stroke ◽  
2012 ◽  
Vol 43 (suppl_1) ◽  
Author(s):  
Wondwossen G Tekle ◽  
Saqib A Chaudhry ◽  
Habib Qaiser ◽  
Ameer E Hassan ◽  
Gustavo J Rodriguez ◽  
...  
Keyword(s):  
United States ◽  
Ischemic Stroke ◽  
Acute Stroke ◽  
Acute Ischemic Stroke ◽  
The United States ◽  
Thrombolytic Treatment ◽  
Stroke Patients ◽  
Referral Patterns ◽  
Hospital Outcomes ◽  
Treatment Paradigm

Background: While single center and regional estimates of thrombolytic administration using drip and ship treatment paradigm are available, patient outcomes, thrombolytic utilization, cost, and referral patterns has not been assessed in United States. Objective: To provide national estimates of patients treated with thrombolytics using drip and ship paradigm and determine the impact of drip and ship treatment on regional thrombolytic utilization, treatment cost, and referral patterns of acute stroke patients in a large cohort. Methods: We determined the proportion of patients treated with drip and ship paradigm among all acute ischemic stroke patients treated with thrombolytic treatment and obtained comparative in-hospital outcomes from the Nationwide Inpatient Survey (NIS) data files from October 2008 to December 2009. All the in-hospital outcomes were analyzed after adjusting for potential confounders using multivariate analysis. Thrombolytic utilization, hospitalization cost, and patterns of referral related to drip and ship treatment of acute stroke were estimated. Results: Of the 26,814 ischemic stroke patients who received thrombolytic treatment, 5144 (19%) were treated using drip and ship paradigm. Seventy nine percent of all the drip and ship treated patients were referred to urban teaching hospitals for further care, and 7% of them received follow up endovascular treatment at the referral facility. States with higher proportion of patients treated using the drip and ship paradigm had higher rates of thrombolytic utilization (3.1% vs. 2.4%, p<0.001). After adjusting for age, gender, presence of hypertension, diabetes mellitus, renal failure, and hospital teaching status, outcomes of patients treated with drip and ship paradigm was similar to those who received thrombolytic and stayed in the same facility: self care (odds ratio [OR], 1.055, 95% confidence interval [CI], 0.910-1.224, p=0.4779); death(OR , 0.821 95% CI, 0.619- 1.088, p=0.1688); and nursing home discharge (OR, 1.023, 95% CI, 0.880- 1.189, p=0.7659) at discharge. Drip and ship paradigm was associated with shorter hospital stay (mean [days, SE] 5.9± 0.18 vs. 7.4 ± 0.15, p<0.001), and lower cost of hospitalization (mean total charges [$, SE) 57,000 ± 3,324 vs. 83,000 ± 3,367, p<0.001). Conclusions: One out of every five patients who received thromboytic treatment in United States is currently treated using drip and ship paradigm with comparable adjusted rates of favorable outcomes. There was a higher rates of thrombolytic utilization in States where drip and ship was more commonly implemented.

Abstract WP54: National Trends in Utilization and Outcomes of Endovascular Treatment in Acute Ischemic Stroke Patients in Pre- and Post-Stent Retriever Era in the United States

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Saqib A Chaudhry ◽  
Ameer E Hassan ◽  
Iqra N Akhtar ◽  
Mohammad Rauf A Chaudhry ◽  
Wei Huang ◽  
...  
Keyword(s):  
United States ◽  
Clinical Trials ◽  
Ischemic Stroke ◽  
Endovascular Treatment ◽  
Acute Ischemic Stroke ◽  
Multivariate Logistic Regression Analysis ◽  
The United States ◽  
Stent Retriever ◽  
Severe Disability ◽  
Stroke Patients

Introduction: Several studies have shown improved outcomes in ischemic stroke patients treated with mechanical thrombectomy in clinical trials after introduction of stent retrievers. The outcomes of patients undergoing endovascular treatment in general practice are expected to improve. We performed this analysis to evaluate trends in utilization of endovascular treatment in acute ischemic stroke and associated rates of death and disability in real world practice. Methods: We obtained data for patients admitted with primary diagnosis of ischemic stroke in United States from 2009-2016 using Nationwide Inpatient Sample. We determined the rate and pattern of utilization, and associated in-hospital outcomes of endovascular treatment among them. Outcomes were classified as minimal disability, moderate to severe disability, and death based on discharge disposition and compared between two time periods: 2009-2011 and 2013-2016 to represent pre and post stent retriever approvals in United States. Results: Of the 3,780,955 patients admitted with ischemic stroke, 244,092 (6.46%) received intravenous thrombolytic treatment, and 48,409 (1.28%) underwent endovascular treatment. There was a fourfold increase in patients who underwent endovascular treatment (0.55% of ischemic strokes in 2009 vs. 2.03% in 2016, trend p < 0.001). In multivariate logistic regression analysis, adjusted for age, gender, thrombolytic therapy, in hospital complications including secondary intracranial hemorrhages, the rate of none to minimal disability improved between the two study intervals (2009-2011 versus 2013-2016), odds ratio (OR) 1.82, 95% confidence interval (CI) 1.47-2.67, p=<0.0001) and moderate to severe disability decreased (OR 0.56, 95% CI 0.45- 0.70, p= <0.0001). There was significant decrease inpatient mortality for patients treated during 2013-2016; OR 0.67, 95% CI 0.56- 0.79, p= <0.0001). Conclusion: There has been a significant increase in the proportion of acute ischemic stroke patients receiving endovascular treatment with improvement of outcomes. Our analysis support generalizability of the successful results observed in clinical trials of endovascular treatment in the post-stent retriever approval era in United States.

Abstract WP13: The Rate of Hemicraniectomy Utilization for Acute Ischemic Stroke Patients Undergoing Endovascular Treatment is Decreasing in the United States

Stroke ◽  
2016 ◽  
Vol 47 (suppl_1) ◽  
Author(s):  
Saqib A Chaudhry ◽  
Ameer E Hassan ◽  
Mohammad R Afzal ◽  
Riaz Riaz ◽  
Haseeb Rahman ◽  
...  
Keyword(s):  
United States ◽  
Ischemic Stroke ◽  
Endovascular Treatment ◽  
Acute Ischemic Stroke ◽  
Endovascular Therapy ◽  
Multivariate Logistic Regression Analysis ◽  
The United States ◽  
Severe Disability ◽  
National Database ◽  
Stroke Patients

Background and Purpose: Hemicraniectomy is carefully selected for patients with acute ischemic stroke in whom endovascular treatment has failed to prevent adverse outcomes of large hemispheric stroke. We evaluated trends in the utilization of hemicraniectomy in patients who underwent endovascular therapy according to the availability of three generations of thrombectomy devices and analyzed the associated rates of death and disability among them over a nine year period. Methods: We obtained data for patients admitted to hospitals in the United States from 2004 to 2012 with a primary diagnosis of ischemic stroke using a large national database. We determined the rate and pattern of hemicraniectomy utilization, and associated in-hospital outcomes of endovascular treatment among ischemic stroke patients. Outcomes were compared between three time periods: 2004-2006 (post MERCI), 2007-2009 (post Penumbra) and 2010-2012 (post Solitaire stent retriever) approvals. Results: Of the 6,021,636 patients admitted with ischemic stroke, 28,956 (0.48%) underwent endovascular treatment. Of the patients who underwent endovascular therapy, 2,219 (7.6%) required subsequent hemicraniectomy. There was a 7 fold decrease in the utilization of hemicraniectomy in these patients between 2004 and 2009 (25.6% in 2004 vs. 3.5% in 2009, p < 0.001) with a yearly trend towards decreased utilization of hemicraniectomy [OR 0.7, 95% CI 0.6- 0.8, p <.0001]. In multivariate logistic regression analysis there was a reduction in the rate of in hospital mortality of the 2007-2009 and the 2010-2012 groups when compared to the 2004-2006 interval group (2007-2009, odds ratio (OR) 0.9, 95% confidence interval (CI) (0.7- 1.2) and 2010-2012, [OR 0.9, 95%CI 0.7- 1.1]). The rate of moderate to severe disability increased for patients treated during 2007-2009 and 2010-2012. Conclusion: In the last 9 years there has been a significant decrease in the utilization of hemicraniectomy in acute ischemic stroke patients who underwent endovascular treatment. Despite reduction in use of hemicraniectomy, the mortality rate in endovascularly treated patients have shown a reduction, but there was an increase in rate of moderate to severe disability.

scholarly journals Drip-and-Ship Thrombolytic Treatment Paradigm Among Acute Ischemic Stroke Patients in the United States

Stroke ◽  
2012 ◽  
Vol 43 (7) ◽  
pp. 1971-1974 ◽  
Author(s):  
Wondwossen G. Tekle ◽  
Saqib A. Chaudhry ◽  
Ameer E. Hassan ◽  
Gustavo J. Rodriguez ◽  
M. Fareed K. Suri ◽  
...  
Keyword(s):  
United States ◽  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
The United States ◽  
Thrombolytic Treatment ◽  
Stroke Patients ◽  
Treatment Paradigm

Abstract 45: Thrombolytic Treatment for In-Hospital Ischemic Strokes in United States

Stroke ◽  
2013 ◽  
Vol 44 (suppl_1) ◽  
Author(s):  
Tenbit Emiru ◽  
Malik M Adil ◽  
Adnan I Qureshi
Keyword(s):  
United States ◽  
Ischemic Stroke ◽  
Length Of Stay ◽  
Hospital Mortality ◽  
Acute Ischemic Stroke ◽  
Clinical Characteristics ◽  
The United States ◽  
Treated Group ◽  
Hospital Charges ◽  
Thrombolytic Treatment

BACKGROUND: Despite the recent emphasis on protocols for emergent triage and treatment of in-hospital acute ischemic stroke, there is little data on rates and outcomes of patients receiving thrombolytics for in-hospital ischemic strokes. OBJECTIVE: To determine the rates of in-hospital ischemic stroke treated with thrombolytics and to compare outcomes with patients treated with thrombolytics on admission. DESIGN/METHODS: We analyzed a seven-year data (2002-2009) from the National Inpatient Survey (NIS), a nationally representative inpatient database in the United States. We identified patients who had in-hospital ischemic strokes (defined by thrombolytic treatment after one day of hospitalization) and those who received thrombolytics on the admission day. We compared demographics, baseline clinical characteristics, in hospital complications, length of stay, hospitalization charges, and discharge disposition, between the two patient groups. RESULT: A total of 18036 (21.5%) and 65912 (78.5%) patients received thrombolytics for in-hospital and on admission acute ischemic stroke, respectively. In hospital complications such as pneumonia (5.0% vs. 3.4%, p=0.0006), deep venous thrombosis (1.9% vs. 0.6%, p<0.0001) and pulmonary embolism (0.8% vs. 0.4%, p=0.01) were significantly higher in the in-hospital group compared to on admission thrombolytic treated group. Hospital length of stay and mean hospital charges were not different between the two groups. Patients who had in-hospital strokes had had higher rates of in hospital mortality (12.1% vs. 10.6%, p=0.02). In a multivariate analysis, in-hospital thrombolytic treated group had higher in-hospital mortality after adjustment for age, gender and baseline clinical characteristics (odds ratio 0.84, 95% confidence interval 0.74-0.95, p=0.008). CONCLUSION/RELEVANCE: In current practice, one out of every five acute ischemic stroke patients treated with thrombolytics is receiving treatment for in-hospital strokes. The higher mortality and complicated hospitalization in such patients needs to be recognized.

Abstract WP41: Age-Specific Differences in the Use of Endovascular Treatment and Hospital Outcomes in Patients With Acute Ischemic Stroke: A Community-Wide Perspective

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Saqib A Chaudhry ◽  
Iqra N Akhtar ◽  
Ameer E Hassan ◽  
Mohammad Rauf A Chaudhry ◽  
Mohsain Gill ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Endovascular Treatment ◽  
Acute Ischemic Stroke ◽  
International Classification Of Diseases ◽  
The United States ◽  
Primary Diagnosis ◽  
Limited Information ◽  
Hospital Outcomes ◽  
The Impact ◽  
Over Time

Background: Relatively limited information is available about trends over time in the use of endovascular treatment in patients of different ages hospitalized with acute ischemic stroke and the association between use of thrombectomy treatment and hospital outcomes in age strata. We performed this analysis to evaluate trends in the utilization of endovascular treatment in acute ischemic stroke by age strata in real-world practice. Methods: We conducted this study by identifying patients admitted with a primary diagnosis of ischemic stroke in the United States from 2007 to 2016 using the Nationwide Inpatient Sample. International Classification of Diseases, ninth revision, and tenth, Clinical Modification (ICD-9-CM, ICD-10-CM) codes were used to identify patients admitted for ischemic stroke and undergoing endovascular treatment. Results: Of the 4,590,533 patients admitted with ischemic stroke, 269,922 (5.88%) received intravenous thrombolytic treatment, and 51,375 (1.12%) underwent endovascular treatment. There is almost 12-fold significant increase in the use of endovascular treatment patients admitted with acute ischemic stroke between 2007 to 2016. Patients who were 75 years and older experienced a marked increase in the receipt of endovascular treatment over time (0.12% 2007; 1.91% 2016; trend p<0.0001). We observed statistically significant improvement in outcomes including minimal disability (6.3% to 18.8%; trend p<0.0001) and in hospital mortality (25.0% to 16.5%; trend p<0.0001) in patients 75 years and older treated with endovascular treatment in study period. We observed similar trend of outcomes in each of the other age-specific groups under study (<55, 55-64 and 65-74 years). Conclusions: Our findings indicate a recent increase in the use of endovascular in middle-aged and elderly patients with acute ischemic strokes. The impact of endovascular treatment on hospital outcomes was observed in each of our age strata understudy though the magnitude of absolute and relative benefit varied according to age.

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