TY - JOUR
T1 - Statewide Trends in Utilization and Outcomes of Endovascular Treatment of Acute Ischemic Stroke
T2 - Analysis of Minnesota Hospital Association Data (2014 and 2015)
AU - Hussein, Haitham M.
AU - Saleem, Muhammad A.
AU - Qureshi, Adnan I.
N1 - Publisher Copyright:
© 2018 National Stroke Association
PY - 2018/3
Y1 - 2018/3
N2 - Background: The study aims at examining the changes in endovascular procedures utilization after the publication of the clinical trials showing their benefit in patients with acute ischemic stroke (AIS). Methods: Minnesota Hospital Association database from 137 member hospitals was used to calculate the statewide utilization rates for 2 periods: prior to (calendar year 2014) and after (calendar year 2015) the publication of multiple randomized clinical trials showing the efficacy of endovascular therapy. Patients were identified using International Classification of Disease, Clinical Modification, 9th revision (ICD-9) or ICD-10 codes (ICD-10 started October 2015). Utilization rates for endovascular treatment were calculated monthly, quarterly, and annually. Results: Of the 13,043 patients admitted with AIS, 434 patients (mean age 68.5 ± 15.5 years; 51.2% women) received endovascular treatment. The number of procedures increased from 194 in 2014 to 240 in 2015. Utilization rate was 3.4% in the first quarter of 2014, gradually declined to reach its lowest value (2.6%) the last quarter of 2014, then steadily increased to reach its peak (4%) in the last quarter of 2015. Procedures performed at comprehensive stroke centers increased from 52% of total procedures in 2014 to 57.5% in 2015, whereas those performed at primary stroke centers decreased from 22.6% to 19.5%. In 2015, fewer patients had hypertension (50.4% versus 60.3%; P =.039) and more patients had chronic kidney disease (28.3% versus 15.5%; P =.001) compared with 2014. Intracranial hemorrhage, mortality rate, and rate of home discharge were similar between the 2 years. Conclusion: Utilization of endovascular procedures for treatment of AIS has been rapidly influenced by medical literature.
AB - Background: The study aims at examining the changes in endovascular procedures utilization after the publication of the clinical trials showing their benefit in patients with acute ischemic stroke (AIS). Methods: Minnesota Hospital Association database from 137 member hospitals was used to calculate the statewide utilization rates for 2 periods: prior to (calendar year 2014) and after (calendar year 2015) the publication of multiple randomized clinical trials showing the efficacy of endovascular therapy. Patients were identified using International Classification of Disease, Clinical Modification, 9th revision (ICD-9) or ICD-10 codes (ICD-10 started October 2015). Utilization rates for endovascular treatment were calculated monthly, quarterly, and annually. Results: Of the 13,043 patients admitted with AIS, 434 patients (mean age 68.5 ± 15.5 years; 51.2% women) received endovascular treatment. The number of procedures increased from 194 in 2014 to 240 in 2015. Utilization rate was 3.4% in the first quarter of 2014, gradually declined to reach its lowest value (2.6%) the last quarter of 2014, then steadily increased to reach its peak (4%) in the last quarter of 2015. Procedures performed at comprehensive stroke centers increased from 52% of total procedures in 2014 to 57.5% in 2015, whereas those performed at primary stroke centers decreased from 22.6% to 19.5%. In 2015, fewer patients had hypertension (50.4% versus 60.3%; P =.039) and more patients had chronic kidney disease (28.3% versus 15.5%; P =.001) compared with 2014. Intracranial hemorrhage, mortality rate, and rate of home discharge were similar between the 2 years. Conclusion: Utilization of endovascular procedures for treatment of AIS has been rapidly influenced by medical literature.
KW - Endovascular treatment
KW - Minnesota Hospital Association
KW - clinical trials
KW - endovascular utilization
KW - intra-arterial treatment for stroke
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U2 - 10.1016/j.jstrokecerebrovasdis.2017.09.056
DO - 10.1016/j.jstrokecerebrovasdis.2017.09.056
M3 - Article
C2 - 29108804
AN - SCOPUS:85032883321
SN - 1052-3057
VL - 27
SP - 677
EP - 681
JO - Journal of Stroke and Cerebrovascular Diseases
JF - Journal of Stroke and Cerebrovascular Diseases
IS - 3
ER -