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Certified stroke centers more likely to provide tPA

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Stroke patients are three times more likely to receive clot-busting medication if treated at a Joint Commission-certified stroke center, according to a study.

Intravenous tissue plasminogen activator is the only drug approved by the Food and Drug Administration for emergency treatment for people who have ischemic stroke. The drug can reduce stroke disability.

“The stroke center concept has rapidly taken off, and this data demonstrates one way that certified centers are doing better than non-certified centers,” Michael T. Mullen, MD, the study’s lead author and an assistant professor of neurology at the Perelman School of Medicine at the University of Pennsylvania, said in a news release.

For a study published March 26 on the website of the Journal of the American Heart Association, researchers examined hospital discharge data on 323,228 ischemic stroke patients from 26 states in 2004-09. Intravenous tPA was administered to 3.3% of patients overall, 6.7% of patients at primary stroke centers certified by the Joint Commission and 2.2% of patients at other facilities.

After the researchers adjusted for patient and facility characteristics, they found the likelihood of receiving tPA remained almost twice as high in certified stroke centers.

Over time, tPA use increased from 6% to 7.6% at certified primary stroke centers and 1.4% to 3.3% at non-certified hospitals.

“Between 10% and 15% of patients arriving at the hospital with ischemic stroke are eligible to receive tPA,” said Eric Smith, MD, chairman of the American Heart Association/American Stroke Association’s Get With The Guidelines-Stroke quality improvement program, and an associate professor of neurology at the University of Calgary. “This research shows that the certification program seems to be working, and that treatment is improving over time.

But “unlike the improvement in the percentage of patients receiving tPA, we haven’t seen comparable improvements in the speed at which patients are evaluated and treated, and that is a major factor in determining outcomes.”

The American Heart Association/American Stroke Association’s Target: Stroke program helps hospitals treat 50% or more of patients within the first hour after they arrive (see www.strokeassociation.org/STROKEORG/Professionals/Target-Stroke_UCM_314495_SubHomePage.jsp for information).

In conjunction with The Joint Commission, the association also offers certification to facilities that meet criteria as Comprehensive Stroke Centers. “We need more complete systems of care to make sure patients are getting to the best facility to treat their stroke — and getting there as quickly as possible,” Smith said.

The full study is available at http://jaha.ahajournals.org/content/2/2/e000071.full.

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