American Stroke Association announces ‘aggressive’ targets to speed care

Hospitals participating in the second phase of a quality improvement program through the American Heart Association/American Stroke Association (AHA/ASA) reduced their median door-to-needle times for acute ischemic stroke patients from 66 minutes to 51 minutes, according to research presented Feb. 6 at the ASA’s International Stroke Conference in Honolulu. And the program is now setting its goals even higher.

Door-to-needle (DTN) time spans the period from patients’ arrival at a healthcare facility until they are given alteplase, a tissue plasminogen activator designed to break up blood clots. Because timely intervention is crucial in improving outcomes after stroke, the AHA/ASA has prioritized improving DTN times as a key metric for the more than 1,200 U.S. hospitals participating in its Target: Stroke program.

“It is a common saying in the stroke community—‘time is brain’—but it is entirely true,” Gregg C. Fonarow, MD, lead study author and co-chief of UCLA’s Division of Cardiology, said in a statement. “Every minute a stroke goes untreated a typical patient loses 1.9 million neurons—so a faster response time is critical to improved patient outcomes.”

Patients treated in Target: Stroke Phase II received alteplase a median 51 minutes from hospital arrival, down from 66 minutes during phase I of the program. The proportion of patients with DTN times of less than an hour increased from 42 percent to 67 percent—a significant improvement but still below phase II’s national goal of 75 percent.

Even though that percentage wasn’t met, the AHA/ASA announced even more ambitious goals for phase III of Target: Stroke. The primary DTN goal of that program is treating at least 85 percent of acute ischemic stroke patients within an hour, with secondary goals of meeting 30- and 45-minute timelines as well.

Phase III will also include the first targets for door-to-device times among patients treated with endovascular therapy. National targets for this metric include treating at least half of patients within 90 minutes if they arrive directly at the hospital or within 60 minutes if they’re transferred from another facility.  

“We see these goals as aggressive—but also completely attainable—and more importantly we believe that it will continue to improve outcomes and save the lives of additional acute ischemic stroke patients,” Fonarow said. “At the end of the day, that is everyone’s goal.”

The improvements in DTN times among hospitals participating in the quality improvement initiative closely mirror those from another U.S. collaboration—the Paul Coverdell National Acute Stroke Program. A recent study found participating hospitals were 7.3 times more likely to administer IV alteplase within an hour of a stroke patient’s arrival in 2017 compared to 2008. In 2017, 66.2 percent of patients treated at those hospitals met that cutoff, which is almost the exact proportion reported from phase II of Target: Stroke.