Treating stroke patients 15 minutes earlier can save lives

According to a new study led by UCLA, published today in the Stroke Treatment (stroke) magazine, only 15 minutes faster can save lives and prevent disability. JAMA. Research has also determined that the busiest hospitals – those that treat more than 450 people with stroke – have better results than those who treat fewer than 400 patients a year.

Researchers from the David Geffen School of Medicine at the University of California at Los Angeles (UCLA) and five other US and Canadian institutions examined data from 6,756 people with ischemic stroke. The median age of the patients was 71 years and 51.2% were women.

The researchers looked at the treatment outcomes of stroke patients in light of the time at which they were performing their "door to puncture", that is to say, the time they were being treated. interval between their arrival at the hospital and the start of treatment.

The data showed that for every 1,000 people whose puncture delay was 15 minutes earlier, 15 fewer people died or were admitted to palliative care, 17 others were able to leave the hospital without badistance. and 22 others take care of it after getting out of the hospital. The researchers found that the median time between the arrival of patients in the hospital and the start of treatment was 27 minutes and that the median time between onset of symptoms and treatment was 3 hours and 50 minutes.

All patients in the study were treated with endovascular reperfusion therapy, which is used to treat strokes caused by blockage of one of the major arteries of the brain.

The study is one of the largest in the world to quantify the number of patients in a thousand who could be saved by earlier stroke treatment, and to do so, uses real data rather than clinical trials, according to the report. Dr. Reza Jahan, co-author and professor of interventional neuroradiology at the Geffen School of Medicine.

In the United States, about 795,000 people suffer from stroke each year and about 140,000 die from it. Ischemic stroke, which occurs when a blood vessel that delivers blood to the brain is obstructed, accounts for 87% of all strokes. (Other types of stroke include hemorrhagic strokes and transient ischemic attacks, sometimes called mini-strokes.)

According to the results of the study, reducing the duration of treatment by 15 minutes could potentially improve outcomes for thousands of people each year.

The study found that hospitals that perform endovascular reperfusion treatment on more than 50 patients a year usually start their treatment faster than those who achieve less than 30; and that initial treatment tends to be delayed in hospitals that are not certified as stroke treatment centers or located in the Northeast, as well as for stroke patients during the Off-peak hours of the hospital – weekends, holidays and before after 18h on weekdays.

"We try to improve treatments with better staffing during off-peak hours and bring doctors to the hospital faster when they are on call," Jahan said. "Patients who arrive at the hospital at 2 in the morning should not be treated differently than people who arrive at 2 am"

Treatment delays are also more likely for people who live alone or who do not recognize their own stroke symptoms.

Based on the results of the study, the American Heart Association has already released new targets regarding the speed with which patients should be treated in comprehensive stroke centers, Jahan said.