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Interhospital transfers result in worse outcomes for stroke patients, study finds

Friday, February 8, 2019
Shah

Transferring stroke patients between hospitals to receive endovascular therapy (EVT) delays treatment and results in poorer health outcomes, a major new study has found. The Circulation article found that transfer-related delays in EVT increased mortality for acute ischemic stroke patients. In addition, compared to patients who received EVT directly, transferred patients were less likely to be discharged from the hospital, less likely to be able to walk on their own, and more likely to have complications such as symptomatic intracranial hemorrhage. These disparities persisted even after accounting for time delays and other factors.

Using data from the Get-with-the-Guidelines stroke database, first author Shreyansh Shah, MD, and colleagues analyzed data from a cohort of more than 1,800,000 ischemic stroke patients admitted to 2,143 participating hospitals between 2012 and 2017. Of 37,260 patients who received EVT during this period, 42.9% received an interhospital transfer as opposed to arriving directly.

Patients who were transferred received EVT, on average, about 67 minutes later than patients who received EVT without a transfer. Analysis of this data revealed that the additional transfer time (as opposed to delivery time at the hospital) accounted for this delay.

“While the delay in treatment and worse outcomes for the transferred patients were expected, the stroke community is taken aback by the extent of the problem revealed by this study,” Shah said. “The fact that of all patients receiving EVT in our country, 45% had to go from one hospital to the other to receive the therapy, highlights how serious is the access issue. The solution to this problem is going to require a number of innovative ideas and collaboration across institutions.”

Endovascular therapy has shown great promise for acute stroke patients with large vessel occlusion. However, the treatment needs to be given promptly in order to be most effective. Because many hospitals cannot provide EVT, interhospital transfers have become increasingly common.

The article has several recommendations to improve patient care. In addition to making EVT more widely available, identifying and triaging patients can also make sure patients that need EVT are brought to facilities that can provide it. Other recommendations include reducing interhospital transfer times and identifying other factors in patients that result in poorer outcomes.

In addition to Shah, other authors of the study were Ying Xian, MD, PhD, Shubin Sheng, PhD, Kori Zachrison, MD, MSc, Jeffrey Saver, MD, Kevin Sheth, MD, Gregg Forarow, MD, Lee Schwamm, MD, and Eric Smith, MD, MPH. The full article is available here.

https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.118.036509