title: National survey of thrombolytic therapy for acute ischemic stroke in Taiwan 2003-2010.
abstract: Data on thrombolytic therapy at the national level is scarce in Asia. Understanding current practice pattern is important for a policy maker in decision making. This cross-sectional study analyzed the utilization pattern of thrombolytic therapy for acute ischemic stroke (AIS) in Taiwan from 2003 through 2010 and identified factors associated with post-therapy intracerebral hemorrhage (ICH) and mortality. From the Taiwan National Health Insurance Research Database, we retrieved inpatient claims for patients with AIS. The frequency of thrombolytic therapy in AIS admissions and its association with the characteristics of patients, physicians, and hospitals were analyzed. Factors predicting ICH and in-hospital mortality were also analyzed using multiple logistic regressions. Of 394,988 patients with AIS, 2385 (.60%) had received thrombolytic therapy. The utilization rate increased from .03% in 2003 to 1.51% in 2010. Thrombolytic therapy was adopted earlier in a belt of high-frequency counties across rural midwestern Taiwan, twice the rate in the Taipei and Kaohsiung cities. The neurology specialty and hospital's service volume were the most dominant factors related to higher utilization, in addition to weekend admission and the patient's age and comorbidities. ICH and in-hospital mortality rates were 3.48% and 7.71%, respectively. Patients given thrombolytic therapy in hospitals with thrombolysis cases more than the 5.5/year had a lower risk of ICH (odds ratio: .53; 95% confidence interval: .31-.88). Compared with most developed countries, there is indeed much unmet need for stroke thrombolysis in Taiwan. Effective mechanism should be implemented to increase the thrombolysis rate safely and improve outcome for patients with AIS.
authors.affiliation: Stroke Center and Department of Neurology, Tainan Sin Lau Hospital, Tainan, Taiwan; Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
authors.forename: Cheng-Yang
authors.initials: CY
authors.lastname: Hsieh
authors.forename: Chih-Hung
authors.initials: CH
authors.lastname: Chen
authors.forename: Yi-Chi
authors.initials: YC
authors.lastname: Chen
authors.forename: Yea-Huei
authors.initials: YH
authors.lastname: Kao Yang
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002545:Brain Ischemia / Q000175:diagnosis / Q000188:drug therapy* / Q000401:mortality; D002543:Cerebral Hemorrhage / Q000139:chemically induced / Q000401:mortality; D003430:Cross-Sectional Studies; D004059:Diffusion of Innovation; D005343:Fibrinolytic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D019538:Health Care Surveys; D017052:Hospital Mortality; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D010818:Practice Patterns, Physicians' / Q000639:trends; D012307:Risk Factors; D020521:Stroke / Q000175:diagnosis / Q000188:drug therapy* / Q000401:mortality; D013624:Taiwan; D015912:Thrombolytic Therapy / Q000009:adverse effects / Q000401:mortality / Q000706:statistics & numerical data / Q000639:trends; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D005343:Fibrinolytic Agents
keywords: Asia; Taiwan; Thrombolytic therapy; acute ischemic stroke; rtPA; utilization pattern