INTRODUCTION

• In acute stroke patients, the time from onset to treatment is an important factor to improve the patient’s health outcomes.
• It is important to receive intravenous tissue-type plasminogen activator(tPA) or endovascular recanalization therapy(ERT) rapidly for ischemic stroke patients.
• Previous study showed that Inter-hospital transfer after use of tPA in acute stroke(drip and ship) may help improve the outcomes in patients.
• In South Korea, considerable variations exist in the availability of healthcare resources for stroke treatment, affecting the inter-hospital transfer.
• Efficient inter-hospital transfer means transferring to a hospital with the level of resources necessary for patient treatment without delay.

AIM

• This study aims to identify efficient inter-hospital transfer by analyzing the 30-day/1-year mortality according transfer and treatment patterns (tPA or ERT).

METHOD

1)    Study population

• A total of 283,740 patients urgently admitted to hospitals with acute ischemic stroke(KCD-7 I63) between 2017 and 2021.

2) Database

• The National Health Insurance(NHI) claims data of HIRA

3) Treatment pattern classification

• The interesting variable was the patterns of inter-hospital transfer and treatment(tPA or ERT).

4) Outcome

• 30-day/1-year mortality after admission

5) Statistical analysis

• Multiple Logistic regression analysis

RESULTS

• Mortality according to inter-hospital transfer and treatment pattern
  • The rate of transferred patients with acute ischemic stroke is 9.3%.
  • Transferred patients had higher mortality(5.2%) than non-transferred patients(4.6%).
  • Patients who received ERT after transfer without tPA treatment in the first hospital had the highest mortality(13.7%)
  • The result of subgroup analysis on patients who received ERT

• Reference : patients who received ERT after use of tPA at the first hospital
• (30-day mortality risk) in patients who performed ERT only after transfer

            → Crude OR 1.39(p=0.0401)., Adjust OR 1.31(p=0.1125)

• (1-year mortality risk) in patients who performed ERT only after transfer

            → Crude OR 1.43(p=0.0023), Adjust OR 1.33(p=0.0289)

CONCLUSIONS

• Interhospital transfer for ERT after use of tPA at the first hospital.may help improve a long-term patient health outcome.
• Even if patients had an indication of ERT, early transferring to a nearby hospital where tPA treatment is available can reduce mortality.
• It is necessary to consider establishing a stroke network so that patients can be transferred directly to the proper hospital for more effective inter-hospital transfer.

ACKNOWLEDGEMENT

• The authors gratefully acknowledge the Healthcare System Enhancement Department of Health Insurance Review and Assessment Service and cooperating hospitals with the cooperation for this article.

REFERENCES

1 Mistry et al. Mechanical Thrombectomy Outcome With and Without Intravenous Thrombolysis in Stroke Patients A Meta-analysis. Stroke 2017;48(9):2405-2456.

2 Fuentes B. et al. Futile interhospital transfer for endovascular treatment in acute ischemic stroke: the madrid stroke network experience. Stroke 2015;46:2156-2161

3 K.S. Zachrison et al. Ischemic Stroke Transfer Patterns in the Northest United States. Journal of Stroke and Cerebrovascular Diseases 2019;28(2):295-304.

CONTACT INFORMATION

• Bomi Lee: bmlee2@hira.or.kr
• Yangjun Shin: shinyj@hira.or.kr
• Choon-Seon Park: parkcs@hira.or.kr
• Ji-Sook Choi^†: banjjakco@hira.or.kr

          † Co-corresponding authors