Patients Reaching Hospital within 'Golden Hour' More Likely to Get Stroke Drug

Patients who arrived at specific hospitals within an hour of experiencing stroke symptoms received a powerful clot-busting drug twice as often as those who arrived later in the approved time window for treatment, according to a new UCLA study presented today at the American Stroke Association's International Stroke Conference 2009.

Among the more than 100,000 patients treated at hospitals participating in the American Heart Association's Get With the Guidelines–Stroke (GWTG–Stroke) quality improvement program, 27.1 percent who arrived within the "golden hour" — the hour following the onset of symptoms — were treated with the clot-busting drug known as tissue plasminogen activator (tPA). Of those who arrived between one and three hours of symptom onset, 12.9 percent received the drug.

"The treatment rate among under-one-hour-arriving patients is good news for Get With the Guidelines hospitals," said lead author Dr. Jeffrey L. Saver, professor of neurology and director of the UCLA Stroke Center at Ronald Reagan UCLA Medical Center. "Prior studies have suggested that 25 to 30 percent of early-arriving patients are fully eligible for clot-busting drug treatment, and Get With the Guidelines–Stroke hospitals are delivering the therapy to virtually all these individuals."

The drug is the only approved acute stroke treatment for clot-related, or ischemic, stroke and has been shown to reduce stroke-related disability. However, it is only approved for use within three hours of symptom onset.

Recently, the European Cooperative Acute Stroke Study suggested that tPA was safe and effective up to 4.5 hours after symptom onset for some patients, but the current research reinforces the importance of quick action by patients and physicians.

"These findings support public education efforts to increase the proportion of patients arriving within the first 30 to 60 minutes after stroke onset," Saver said. "Little has been known about how frequently patients arrive at a hospital within the golden hour or how often hospitals meet the guidelines for beginning tPA infusion within 60 minutes after hospital arrival."

Researchers reviewed the records of 106,924 ischemic stroke patients treated during a four-plus-year period at 905 GWTG–Stroke hospitals.

The analysis found that:
• 28.3 percent of patients arrived within 60 minutes of symptom onset.
• 31.7 percent arrived one to three hours after symptoms started.
• 40.1 percent arrived more than three hours after symptoms started.

"That more than one-quarter of ischemic stroke patients arrived within the golden hour is a very encouraging finding, because in stroke, time lost is brain lost," Saver said. "However, more than 70 percent arrived beyond the golden hour, when larger amounts of brain damage have occurred and our chance to reverse damage is much reduced. We have a great deal of additional work to do in educating the public and stroke center staffs. For every minute in which blood flow is not restored, nearly 2 million additional nerve cells die."