HONOLULU – One out of every five patients in the United States who receives thrombolytic therapy for an acute ischemic stroke gets it for a stroke occurring when they’re already hospitalized for another reason.
These thrombolytic-treated in-hospital strokes are associated with significantly increased complication and procedural intervention rates, longer length of stay, higher hospital charges, and greater risk of inpatient mortality, compared with out-of-hospital ischemic strokes in patients who get thrombolytic therapy upon presentation, Dr. Tenbit Emiru reported at the International Stroke Conference, which was sponsored by the American Heart Association.
Dr. Tenbit Emiru
Dr. Emiru’s study is also scheduled to be presented at the annual meeting of the American Academy of Neurology in San Diego on March 21.
She presented an analysis of data for the years 2002-2010 from the National Inpatient Sample, a large, nationally representative hospital database. During the 8-year study period, the database captured more than 24,000 patients who received thrombolytic therapy for an in-hospital acute ischemic stroke and 112,000 others who got a thrombolytic agent for an out-of-hospital ischemic stroke. Thus, 18% of all thrombolytic therapy for acute stroke was administered to patients whose stroke occurred in the hospital.
In-hospital mortality was 11% in thrombolytic-treated patients with in-hospital stroke and 10% in those treated for an out-of-hospital stroke. In a multivariate analysis adjusted for age, gender, and baseline risk factors, patients treated for in-hospital stroke had a statistically significant 10% increased risk of mortality, said Dr. Emiru of the Zeenat Qureshi Stroke Research Center at the University of Minnesota, Minneapolis.
The discharge rate with minimal or no disability was 36% for the in-hospital stroke group and 38% in those treated upon presentation with out-of-hospital stroke, a nonsignificant difference.
The mean length of stay was 8 days in the in-hospital stroke group and 7 days in the comparison group. The in-hospital stroke group had significantly higher rates of in-hospital pneumonia, deep venous thrombosis (DVT), sepsis, and pulmonary embolism, although the absolute differences were small. For example, pneumonia occurred in 5% of patients treated for in-hospital acute ischemic stroke, compared with 3% with out-of-hospital stroke, while DVT was a complication in 2% and 0.7%, respectively.
The disparity between in-hospital procedures for the two groups was more pronounced. For example, 31% of patients treated for in-hospital stroke underwent angiography, compared with 19% of out-of-hospital stroke patients. Those who got thrombolytic therapy for in-hospital stroke also had significantly higher rates of carotid angioplasty (5% vs. 2%) and carotid endarterectomy (3% vs. 1%), Dr. Emiru continued.
Hospital charges averaged $74,713 for patients with in-hospital stroke and $68,419 for those with out-of-hospital stroke.
Audience members indicated that they would have welcomed data on time to treatment from stroke onset for the two groups, as well as information on the reasons for hospitalization in the patients with in-hospital stroke. Neither issue was examined in the study. One audience member commented that the most obvious explanation for the worse outcomes in the thrombolytic-treated patients with in-hospital stroke is that they were sicker to begin with, as evidenced by the fact that were already hospitalized at the time of their ischemic stroke.
Dr. Emiru reported having no financial conflicts.