Certified stroke centers more likely to give clot-busting drugs

Stroke patients are three times more likely to receive clot-busting medication if treated at a certified stroke center, according to a study in the Journal of the American Heart Association.

Intravenous tissue plasminogen activator (tPA) is the only drug approved by the Food and Drug Administration for emergency treatment for people who have ischemic (clot-caused) stroke. The durg 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,” said Michael T. Mullen, M.D., the study’s lead author and an assistant professor of neurology at the Perelman School of Medicine at the University of Pennsylvania in Philadelphia.

The researchers examined hospital discharge data on 323,228 ischemic stroke patients from 26 states in 2004-09.

The clot-buster was administered to:

  3.1 percent of patients overall;
  6.7 percent of patients at primary stroke centers certified by the Joint Commission; and
  2.2 percent of patients at other facilities.

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

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

During a stroke, blood flow must be restored quickly and tPA can only be administered in the first few hours after symptoms start.

“Between 10 percent to 15 percent of patients arriving at the hospital with ischemic strokes are eligible to receive tPA,” said Eric Smith, M.D., chair 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.

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 outcome.”

The American Heart Association/American Stroke Association’s Target: Stroke program helps hospitals treat 50 percent or more of patients within the first hour after they arrive.

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.

At the first sign of a stroke, call 9-1-1 to get to the facility that provides appropriate treatment. The American Stroke Association has more information and tools, including a new mobile app, that can help you recognize and respond to stroke symptoms.


Co-authors are Scott Kasner, M.D.; Michael Kallan, M.S.; Dawn Kleindorfer, M.D.; Karen Albright, D.O., M.P.H.; and Brendan Carr, M.D., M.S. Author disclosures are on the manuscript.

The Agency for Health Care Research and Quality, National Institutes of Health, funded the research. For the latest heart and stroke news, follow @HeartNews on Twitter. For science updates from the Journal of the American Heart Association, follow @jaha_aha on Twitter and “like” JAHA on Facebook.

Statements and conclusions of study authors published in American Heart Association scientific journals are solely those of the study authors and do not necessarily reflect the association’s policy or position. The association makes no representation or guarantee as to their accuracy or reliability. The association receives funding primarily from individuals; foundations and corporations (including pharmaceutical, device manufacturers and other companies) also make donations and fund specific association programs and events. The association has strict policies to prevent these relationships from influencing the science content.


Cathy Lewis

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American Heart Association

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