Consent delay common reason for lag in tPA administration
Consent delay is one of the most common reasons stroke patients in New York State don’t receive tissue plasminogen activator (tPA) within the first hour (called the “Golden Hour”) of hospital arrival, researchers reported at the American Stroke Association’s International Stroke Conference 2015.
Hospitals target administration of the clot-busting drug within 60 minutes of stroke patients’ arrivals, but miss the goal in more than 50 percent of cases. Researchers studied reasons for tPA delays among 22,620 ischemic stroke patients at 120 New York hospitals.
Delays in tPA administration occurred in 1,145 patients, and reasons for those delays were given in 1,116 patients. Among those they found:
- Patient/family consent was a factor in delay in 239, or 21 percent of cases.
- Management of other emergency health conditions caused delays, which occurred in 21 percent of cases.
- Women were much more likely to experience delay due to patient/family consent than men.
- Delay due to patient/family consent was more likely on weekends than weekdays.
This state-level study suggests training and tools to improve and shorten the consent process might reduce delays in tPA treatment. Researchers should delve into why these delays occur more with female stroke patients and on weekends, researchers said.
Sheree Murphy, M.S., C.P.H.Q., American Heart/American Stroke Association, New York, N.Y.
Abstract 206 and Abstract 14
*3181/206 contains updated numbers not in the abstract.
Insertable cardiac monitoring cost-effectively detects post-stroke irregular heartbeat
Insertable cardiac monitoring (ICM) cost-effectively detects irregular heartbeat or atrial fibrillation episodes and episode duration in patients who have had cryptogenic strokes (cause of stroke unknown), according to two studies presented at the American Stroke Association’s International Stroke Conference 2015.
Doctors cannot determine the cause of ischemic stroke in 20 percent to 40 percent of cases, despite conventional diagnostic tests. But they need to document atrial fibrillation in order to prescribe anticoagulant therapy to reduce recurrent stroke risk.
ICMs are inserted under the skin in a minimally invasive procedure to monitor patients’ heartbeats for three years, compared to electrocardiograms, which are tests given on the spot in doctors’ offices or hospitals, and Holter monitors, which patients wear from 24 hours to several days.
To help determine if an ICM is effective, researchers analyzed 1,247 cryptogenic stroke patients who received an ICM device post stroke (abstract 206).