title: Stroke thrombolysis in England: an age stratified analysis of practice and outcome.
abstract: BACKGROUND
  until very recently, only small numbers of older patients with stroke had been recruited into randomised controlled trials of thrombolysis with recombinant tissue plasminogen activator (rt-PA) and patients aged >80 are excluded in the European licence for this therapy. We aimed to estimate the use and outcome of stroke thrombolysis in England across age groups, including the oldest-old.
  
  
  METHODS
  data were collected as part of the Stroke Improvement National Audit Programme. All adults receiving thrombolysis for acute ischaemic stroke as part of routine care between April 2010 and November 2011 were included. Multilevel multivariable logistic regression was used to analyse the associations between age, process of care and 30-day mortality.
  
  
  RESULTS
  of 37,151 adults admitted with acute ischaemic stroke, 3,374 (9.1%) received rt-PA. Patients aged >80 accounted for 21% of the thrombolysis recipients and 4.8% of patients in this age group received rt-PA. Treatment times were similar across all age groups, but older thrombolysis recipients were more likely to have Total anterior circulation infarct strokes and less likely to be functionally independent prior to stroke. Similar rates of post-thrombolysis complications were observed between patients aged >80 and younger patients. Mortality was high among older patients whether they were treated with rt-PA or not. Among patients treated with rt-PA, those aged 81-90 and >90 had, respectively, 34 and 270% higher odds of 30-day mortality than patients aged 70-80.
  
  
  CONCLUSIONS
  treatment with rt-PA is now carried out frequently for older stroke patients in England. Their care is as timely as younger patients with no higher risk of major complication but mortality rates in older patients with stroke remain high.
authors.affiliation: Division of Health and Social Care Research, Kings College London, 7th Floor Capital House 42 Weston Street, London SE1 3DQ, UK. benjamin.bray@kcl.ac.uk
authors.forename: Benjamin D
authors.initials: BD
authors.lastname: Bray
authors.forename: James
authors.initials: J
authors.lastname: Campbell
authors.forename: Alex
authors.initials: A
authors.lastname: Hoffman
authors.forename: Pippa J
authors.initials: PJ
authors.lastname: Tyrrell
authors.forename: Charles D A
authors.initials: CD
authors.lastname: Wolfe
authors.forename: Anthony G
authors.initials: AG
authors.lastname: Rudd
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D016009:Chi-Square Distribution; D004739:England / Q000453:epidemiology; D005260:Female; D005343:Fibrinolytic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D006297:Health Services Accessibility; D006801:Humans; D016015:Logistic Models; D008297:Male; D008485:Medical Audit; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D010043:Outcome and Process Assessment, Health Care; D018579:Patient Selection; D010818:Practice Patterns, Physicians'; D058996:Quality Improvement; D011994:Recombinant Proteins / Q000627:therapeutic use; D012307:Risk Factors; D020521:Stroke / Q000188:drug therapy* / Q000401:mortality; D015912:Thrombolytic Therapy / Q000009:adverse effects / Q000401:mortality; D013997:Time Factors; D010959:Tissue Plasminogen Activator / Q000009:adverse effects / Q000627:therapeutic use*; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D005343:Fibrinolytic Agents; D011994:Recombinant Proteins; D010959:Tissue Plasminogen Activator