Treatment with tissue plasminogen activator and inpatient mortality rates for patients with ischemic stroke treated in community hospitals.
OBJECTIVE
Most analyses of intravenous tissue plasminogen activator (IV tPA) use for acute stroke in routine practice have been limited by sample size and generally restricted to patients treated in large academic medical facilities. In the present study, we sought to estimate among community hospitals the use of IV tPA and to identify factors associated with the use of IV tPA and inpatient mortality.


METHODS
We evaluated a retrospective cohort of 23 058 patients with ischemic stroke from 137 community hospitals.


RESULTS
Three hundred sixty-two (1.6%) patients were treated with IV tPA, and 9.9% of those patients died during the hospitalization period. In 35.0% of the hospitals, no patients were treated with IV tPA, whereas 14.6% of hospitals treated approximately 3.0% with IV tPA. After control for multiple factors, younger patients, more severely ill patients (OR 2.02, 95% CI 1.36 to 3.01), and patients treated in rural hospitals (OR 1.80, 95% CI 0.99 to 3.26) were more likely to receive IV tPA, whereas black patients were less likely (OR 0.54, 95% CI 0.31 to 0.95). There also was a trend showing that women were less likely to receive IV tPA (OR 0.84, 95% CI 0.69 to 1.03). Factors associated with an increased odds of inpatient mortality included receipt of IV tPA among men (OR 2.81, 95% CI 1.72 to 4.58) and increased age. Black patients were 27% less likely to die during hospitalization (95% CI 0.60 to 0.90).


CONCLUSIONS
In this large, retrospective evaluation of community hospital practice, the use IV tPA and inpatient mortality rates among IV tPA-treated patients were consistent with those of other studies. The likelihood of receiving IV tPA varies by race, age, disease severity, and possibly gender. These factors may influence mortality rates.
Reed
S D
SD
Pharmaceutical Outcomes Research and Policy Program, School of Pharmacy, Department of Neurology, School of Medicine, University of Washington, Seattle, Washington, USA.
Cramer
S C
SC
Blough
D K
DK
Meyer
K
K
Jarvik
J G
JG
D000368:Aged; D000369:Aged, 80 and over; D002545:Brain Ischemia / Q000188:drug therapy / Q000401:mortality*; D015331:Cohort Studies; D015897:Comorbidity; D003920:Diabetes Mellitus; D005260:Female; D017052:Hospital Mortality / Q000639:trends*; D006764:Hospitals, Community / Q000145:classification / Q000639:trends*; D006801:Humans; D015994:Incidence; D007275:Injections, Intravenous; D007297:Inpatients / Q000706:statistics & numerical data; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D044469:Racial Groups; D012189:Retrospective Studies; D018570:Risk Assessment; D012737:Sex Factors; D020521:Stroke / Q000188:drug therapy / Q000401:mortality*; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage*; D014481:United States
D010959:Tissue Plasminogen Activator