Detrimental Delay in Stroke Treatment

Every 15-minute delay in delivering a clot-busting drug after stroke robs survivors of an average month of healthy life. Streamlining the time from symptom onset to clot-busting treatment by just one minute means one less day of disability for a survivor. While all stroke patients benefit from faster treatment, younger patients seem to gain more benefit than older patients.

 

On the other hand, speeding treatment by just one minute means another 1.8 days of healthy life, researchers said.

 

“‘Save a minute; save a day’ is the message from our study, which examined how even small reductions in treatment delays might benefit patients measurably in the long run,'” said Atte Meretoja, M.D., Ph.D., M.Sc., lead author of the study and associate professor of Neurology at the University of Melbourne in Australia.

  • Stroke, as you may know, is the sudden loss of brain function caused by either the interruption of blood flow to the brain (ischemic stroke) or the rupture of blood vessels in the brain (hemorrhagic stroke). In both of these cases, neurons within the affected area begin to die.

Photo Credit: American Heart Association

The clot-busting drug tissue plasminogen activator (tPA) to treat ischemic stroke, should be given within 4.5 hours of symptom onset. However, the sooner it’s given, the better the outcome.

“Clot-busting treatment works equally well, irrespective of race, ethnicity or gender,” Meretoja said. “Speedy restoration of blood flow to the brain is crucial for brain cell survival everywhere.”

The world’s fastest stroke services in Helsinki, Finland and Melbourne, Australia, take an average 20 minutes from hospital arrival to start of treatment, he said. Most American, Australian and European centers take 70-80 minutes.

“In this study, we wanted to quantify the importance of speed in the hope that concrete easy-to-relate-to figures will inspire medical services to measure and improve their game for the benefit of our stroke patients,” Meretoja said.

Meretoja and colleagues used evidence from the combined major clot-busting trials reported to date. They applied those findings to 2,258 consecutive stroke patients from Australia and Finland to calculate what the patient outcomes would have been if they had been treated faster or slower.

They found:

  • For every minute the treatment could be delivered faster, patients gained an average 1.8 days of extra healthy life; and
  • Although all patients benefited from faster treatment, younger patients with longer life expectancies gained a little more than older patients.

“In stroke treatment, every minute saved gives patients days of healthy life,” Meretoja said. “Patients should never wait a single minute for stroke signs, such as face droop, arm weakness or speech disturbance, to go away. They should call for help immediately. Additionally, most emergency medical services and hospitals have the ability to reduce response and treatment delays significantly, and we have described how to do this.”

The study’s findings are generalizable to the U.S. population.

Materials provided by American Heart Association.

Source: American Heart Association. “Stroke survivors may lose month of healthy life for 15-minute delay in treatment.” ScienceDaily. ScienceDaily, 13 March 2014. www.sciencedaily.com/releases/2014/03/140313164507.htm.

Journal Reference:

  1. A. Meretoja, M. Keshtkaran, J. L. Saver, T. Tatlisumak, M. W. Parsons, M. Kaste, S. M. Davis, G. A. Donnan, L. Churilov. Stroke Thrombolysis: Save a Minute, Save a Day. Stroke, 2014; DOI: 10.1161/STROKEAHA.113.002910

 

 

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