United States trends in thrombolysis for older adults with acute ischemic stroke

Benjamin P. George, Anthony O. Asemota, E. Ray Dorsey, Adil H. Haider, Blair J. Smart, Victor C. Urrutia, Eric B. Schneider

Research output: Research - peer-reviewArticle

Abstract

Objective Thrombolysis for ischemic stroke has been increasing in the United States. We sought to investigate recent trends in thrombolysis use in older adults. Methods A retrospective, observational analysis of hospitalization data from the Nationwide Inpatient Sample (NIS) in 2005-2010 was performed. Older adults (≥65 years) admitted with a primary diagnosis of acute ischemic stroke were included. Trends in the population-based rates of thrombolysis and outcomes from the NIS were evaluated using the Cochran-Armitage test. Results Thrombolysis in older adult stroke patients increased from 1.7% to 5.4% (2005-2010; trend P <0.001). Large increases were observed among urban patients, urban hospitals, and high volume facilities. Individuals ≥85 years were less likely to receive thrombolysis than younger ages throughout the study period, although there was an increase from an odds ratio of 0.50 (95% CI: 0.44-0.57) to 0.75 (95% CI: 0.69-0.81) from 2005-2006 to 2009-2010 when compared to 65-74 year olds. For those receiving thrombolysis, no change was observed in intracerebral hemorrhage over time. In-hospital mortality rates did not change significantly over the study period for age subgroups and length of stay declined from 2005 to 2010 for the thrombolysis group (7.6 vs 7.0 days; trend P <0.001). Conclusions Rates of thrombolysis in older adults progressively increased, especially in the oldest old. Increases were largely driven by urban and high volume hospitals.

LanguageEnglish (US)
Pages16-23
Number of pages8
JournalClinical Neurology and Neurosurgery
Volume139
DOIs
StatePublished - Dec 12 2015

Fingerprint

Stroke
Inpatients
High-Volume Hospitals
Urban Hospitals
Cerebral Hemorrhage
Hospital Mortality
Length of Stay
Hospitalization
Odds Ratio
Mortality
Population

Keywords

  • Epidemiology
  • Ischemic stroke
  • Thrombolysis
  • Tissue plasminogen activator
  • tPA

ASJC Scopus subject areas

  • Clinical Neurology
  • Surgery

Cite this

George, B. P., Asemota, A. O., Dorsey, E. R., Haider, A. H., Smart, B. J., Urrutia, V. C., & Schneider, E. B. (2015). United States trends in thrombolysis for older adults with acute ischemic stroke. Clinical Neurology and Neurosurgery, 139, 16-23. DOI: 10.1016/j.clineuro.2015.08.031

United States trends in thrombolysis for older adults with acute ischemic stroke. / George, Benjamin P.; Asemota, Anthony O.; Dorsey, E. Ray; Haider, Adil H.; Smart, Blair J.; Urrutia, Victor C.; Schneider, Eric B.

In: Clinical Neurology and Neurosurgery, Vol. 139, 12.12.2015, p. 16-23.

Research output: Research - peer-reviewArticle

George, BP, Asemota, AO, Dorsey, ER, Haider, AH, Smart, BJ, Urrutia, VC & Schneider, EB 2015, 'United States trends in thrombolysis for older adults with acute ischemic stroke' Clinical Neurology and Neurosurgery, vol 139, pp. 16-23. DOI: 10.1016/j.clineuro.2015.08.031
George BP, Asemota AO, Dorsey ER, Haider AH, Smart BJ, Urrutia VC et al. United States trends in thrombolysis for older adults with acute ischemic stroke. Clinical Neurology and Neurosurgery. 2015 Dec 12;139:16-23. Available from, DOI: 10.1016/j.clineuro.2015.08.031
George, Benjamin P. ; Asemota, Anthony O. ; Dorsey, E. Ray ; Haider, Adil H. ; Smart, Blair J. ; Urrutia, Victor C. ; Schneider, Eric B./ United States trends in thrombolysis for older adults with acute ischemic stroke. In: Clinical Neurology and Neurosurgery. 2015 ; Vol. 139. pp. 16-23
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