Characteristics and Outcomes of Very Elderly Enrolled in a Prehospital Stroke Research Study.
Greater numbers of individuals aged ≥80 years enjoy a high quality of life, yet historically stroke trials have excluded this population. We aimed to describe a population of very elderly successfully enrolled into an acute stroke trial and compare their characteristics and outcomes with the younger cohort.



We analyzed consecutive patients enrolled <2 hours of symptom onset in a prehospital stroke treatment trial, the FAST-MAG clinical trial (Field Administration of Stroke Therapy-Magnesium). We gathered demographic, treatment, and outcome data for nonelderly (<80 years old), very elderly (≥80 years old), and extreme elderly (≥90 years old). We describe key differences in the population of elderly and the impact of their inclusion on the clinical trial.



Of 1700 participants in FAST-MAG, there were 1210 nonelderly, 490 very elderly, and 60 extreme elderly subjects. Very elderly stroke patients successfully enrolled in a research study were more likely to be women, white, and have an ischemic mechanism rather than an intracerebral hemorrhage. Although the very elderly had generally poorer outcomes, 4 in 10 were functionally independent at 90 days.



Inclusion of the very elderly population in acute stroke clinical trials would both significantly increase study participation and generalizability of future acute stroke clinical trials.



URL: http://www.clinicaltrials.gov. Unique identifier: NCT00059332.
From the Department of Neurology, Roxanna Todd Hodges Comprehensive Stroke Clinic (N.S., K.C.A., A.M.B.), and Department of Emergency Medicine (M.E.), University of Southern California, Los Angeles; Department of Neurology, Stroke Center (D.S.L., S. Starkman, J.L.S.) and Neurovascular Imaging Core Laboratory (D.S.L.) and School of Public Health (S. Stratton), University of California, Los Angeles; National Institutes of Neurological Disorders and Stroke, Bethesda, MD (R.C.); Department of Emergency Medicine, Torrance Memorial Medical Center, Torrance, CA (F.P.); Department of Neurology, Stanford University, CA (S.H.). sanossia@yahoo.com.
Nerses
N
Sanossian
From the Department of Neurology, Roxanna Todd Hodges Comprehensive Stroke Clinic (N.S., K.C.A., A.M.B.), and Department of Emergency Medicine (M.E.), University of Southern California, Los Angeles; Department of Neurology, Stroke Center (D.S.L., S. Starkman, J.L.S.) and Neurovascular Imaging Core Laboratory (D.S.L.) and School of Public Health (S. Stratton), University of California, Los Angeles; National Institutes of Neurological Disorders and Stroke, Bethesda, MD (R.C.); Department of Emergency Medicine, Torrance Memorial Medical Center, Torrance, CA (F.P.); Department of Neurology, Stanford University, CA (S.H.).
Kathleen C
KC
Apibunyopas
From the Department of Neurology, Roxanna Todd Hodges Comprehensive Stroke Clinic (N.S., K.C.A., A.M.B.), and Department of Emergency Medicine (M.E.), University of Southern California, Los Angeles; Department of Neurology, Stroke Center (D.S.L., S. Starkman, J.L.S.) and Neurovascular Imaging Core Laboratory (D.S.L.) and School of Public Health (S. Stratton), University of California, Los Angeles; National Institutes of Neurological Disorders and Stroke, Bethesda, MD (R.C.); Department of Emergency Medicine, Torrance Memorial Medical Center, Torrance, CA (F.P.); Department of Neurology, Stanford University, CA (S.H.).
David S
DS
Liebeskind
From the Department of Neurology, Roxanna Todd Hodges Comprehensive Stroke Clinic (N.S., K.C.A., A.M.B.), and Department of Emergency Medicine (M.E.), University of Southern California, Los Angeles; Department of Neurology, Stroke Center (D.S.L., S. Starkman, J.L.S.) and Neurovascular Imaging Core Laboratory (D.S.L.) and School of Public Health (S. Stratton), University of California, Los Angeles; National Institutes of Neurological Disorders and Stroke, Bethesda, MD (R.C.); Department of Emergency Medicine, Torrance Memorial Medical Center, Torrance, CA (F.P.); Department of Neurology, Stanford University, CA (S.H.).
Sidney
S
Starkman
From the Department of Neurology, Roxanna Todd Hodges Comprehensive Stroke Clinic (N.S., K.C.A., A.M.B.), and Department of Emergency Medicine (M.E.), University of Southern California, Los Angeles; Department of Neurology, Stroke Center (D.S.L., S. Starkman, J.L.S.) and Neurovascular Imaging Core Laboratory (D.S.L.) and School of Public Health (S. Stratton), University of California, Los Angeles; National Institutes of Neurological Disorders and Stroke, Bethesda, MD (R.C.); Department of Emergency Medicine, Torrance Memorial Medical Center, Torrance, CA (F.P.); Department of Neurology, Stanford University, CA (S.H.).
Adrian M
AM
Burgos
From the Department of Neurology, Roxanna Todd Hodges Comprehensive Stroke Clinic (N.S., K.C.A., A.M.B.), and Department of Emergency Medicine (M.E.), University of Southern California, Los Angeles; Department of Neurology, Stroke Center (D.S.L., S. Starkman, J.L.S.) and Neurovascular Imaging Core Laboratory (D.S.L.) and School of Public Health (S. Stratton), University of California, Los Angeles; National Institutes of Neurological Disorders and Stroke, Bethesda, MD (R.C.); Department of Emergency Medicine, Torrance Memorial Medical Center, Torrance, CA (F.P.); Department of Neurology, Stanford University, CA (S.H.).
Robin
R
Conwit
From the Department of Neurology, Roxanna Todd Hodges Comprehensive Stroke Clinic (N.S., K.C.A., A.M.B.), and Department of Emergency Medicine (M.E.), University of Southern California, Los Angeles; Department of Neurology, Stroke Center (D.S.L., S. Starkman, J.L.S.) and Neurovascular Imaging Core Laboratory (D.S.L.) and School of Public Health (S. Stratton), University of California, Los Angeles; National Institutes of Neurological Disorders and Stroke, Bethesda, MD (R.C.); Department of Emergency Medicine, Torrance Memorial Medical Center, Torrance, CA (F.P.); Department of Neurology, Stanford University, CA (S.H.).
Marc
M
Eckstein
From the Department of Neurology, Roxanna Todd Hodges Comprehensive Stroke Clinic (N.S., K.C.A., A.M.B.), and Department of Emergency Medicine (M.E.), University of Southern California, Los Angeles; Department of Neurology, Stroke Center (D.S.L., S. Starkman, J.L.S.) and Neurovascular Imaging Core Laboratory (D.S.L.) and School of Public Health (S. Stratton), University of California, Los Angeles; National Institutes of Neurological Disorders and Stroke, Bethesda, MD (R.C.); Department of Emergency Medicine, Torrance Memorial Medical Center, Torrance, CA (F.P.); Department of Neurology, Stanford University, CA (S.H.).
Frank
F
Pratt
From the Department of Neurology, Roxanna Todd Hodges Comprehensive Stroke Clinic (N.S., K.C.A., A.M.B.), and Department of Emergency Medicine (M.E.), University of Southern California, Los Angeles; Department of Neurology, Stroke Center (D.S.L., S. Starkman, J.L.S.) and Neurovascular Imaging Core Laboratory (D.S.L.) and School of Public Health (S. Stratton), University of California, Los Angeles; National Institutes of Neurological Disorders and Stroke, Bethesda, MD (R.C.); Department of Emergency Medicine, Torrance Memorial Medical Center, Torrance, CA (F.P.); Department of Neurology, Stanford University, CA (S.H.).
Sam
S
Stratton
From the Department of Neurology, Roxanna Todd Hodges Comprehensive Stroke Clinic (N.S., K.C.A., A.M.B.), and Department of Emergency Medicine (M.E.), University of Southern California, Los Angeles; Department of Neurology, Stroke Center (D.S.L., S. Starkman, J.L.S.) and Neurovascular Imaging Core Laboratory (D.S.L.) and School of Public Health (S. Stratton), University of California, Los Angeles; National Institutes of Neurological Disorders and Stroke, Bethesda, MD (R.C.); Department of Emergency Medicine, Torrance Memorial Medical Center, Torrance, CA (F.P.); Department of Neurology, Stanford University, CA (S.H.).
Scott
S
Hamilton
From the Department of Neurology, Roxanna Todd Hodges Comprehensive Stroke Clinic (N.S., K.C.A., A.M.B.), and Department of Emergency Medicine (M.E.), University of Southern California, Los Angeles; Department of Neurology, Stroke Center (D.S.L., S. Starkman, J.L.S.) and Neurovascular Imaging Core Laboratory (D.S.L.) and School of Public Health (S. Stratton), University of California, Los Angeles; National Institutes of Neurological Disorders and Stroke, Bethesda, MD (R.C.); Department of Emergency Medicine, Torrance Memorial Medical Center, Torrance, CA (F.P.); Department of Neurology, Stanford University, CA (S.H.).
Jeffrey L
JL
Saver
D000368:Aged; D000369:Aged, 80 and over; D002545:Brain Ischemia / Q000150:complications / Q000453:epidemiology*; D002543:Cerebral Hemorrhage / Q000150:complications / Q000453:epidemiology*; D002986:Clinical Trials as Topic / Q000592:standards / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008274:Magnesium / Q000627:therapeutic use; D008297:Male; D017063:Outcome Assessment, Health Care / Q000706:statistics & numerical data*; D018579:Patient Selection; D012307:Risk Factors; D020521:Stroke / Q000188:drug therapy / Q000453:epidemiology* / Q000209:etiology
D008274:Magnesium
aged; emergency medical services; hemorrhage; quality of life; stroke