Older Patients and Those With Altered Mental Status More Likely to Die in Hospital After Treatment for Stroke
The most common type of ]]>stroke]]> , called an ischemic stroke, results from clogged blood vessels in the brain. Currently the only approved treatment for ischemic stroke is the intravenous administration of tissue plasminogen activator (tPA). Treatment with tPA helps dissolve clots blocking the blood vessels, at least partially restoring blood flow to the brain.
However, very few stroke victims receive tPA treatment. A large majority of hospitalized patients are not treated with tPA because they are admitted more than three hours after the onset of stroke symptoms, which is beyond the time window approved for tPA treatment. Yet many patients admitted within the three-hour time frame are still not treated with tPA due to uncertainties regarding its risks and benefits.
A new study published in the October 20, 2004 issue of the Journal of the American Medical Association sought to identify factors associated with early death in patients treated with tPA, so that health care providers may give special attention to patients who are at high risk. The researchers found that patients with disturbances of consciousness and those in higher age groups were at increased risk of death during hospitalization for tPA treatment.
About the Study
Researchers from the University of Muenster studied 1658 German patients with ischemic stroke who were hospitalized for treatment with tPA. The patients were identified through the German Stroke Registers Study Group, a network of hospital-based stroke registries that monitors quality of stroke care in Germany. The researchers enrolled patients between 2000 and 2002 from 225 different hospitals.
The study followed patients during their hospital stay as they were treated with tPA and the researchers recorded mortality as the main outcome of the study.
Approximately 10% (166) of all patients who received tPA died during hospitalization. The researchers found that older age and disturbances of consciousness were two factors associated with in-hospital death after tPA use. The highest risk of death during hospitalization was in patients who were older than 75 years and had signs of disturbances of consciousness.
In addition, stroke complications, such as bleeding in the brain, a second stroke, and ]]>pneumonia]]> , were associated with increased risk of early mortality.
Another interesting, but not unexpected, finding was that hospitals with more experience in administering tPA had lower rates of death than the hospitals that were less experienced.
A major limitation of this study is that the effectiveness and benefit of treatment with tPA was not assessed. No comparison was made between treatment with tPA and no treatment in older patients. In other words, the researchers simply observed that in patients treated with tPA, older patients and those with altered consciousness appeared to be more likely to die than other patients treated with tPA. Thus it is not clear from this study whether older people who do not receive tPA would fair any better than those who do receive tPA treatment.
How Does This Affect You?
These findings alone are unlikely to significantly affect the treatment of ischemic stroke in older patients or those with disturbances in consciousness. It is important to emphasize that this study did not test whether this therapy was better or worse than no treatment. It does suggest, however, that doctors deciding whether or not to administer tPA in older adults should consider their level of consciousness.
What the study does highlight is that being aware of the signs and symptoms of a stroke, in order to receive medical attention as soon as possible, may improve your chances of receiving a treatment such as tPA.
In addition, you may want to research hospitals in your area. In the event of stroke symptoms, it may be beneficial to seek out a nearby hospital that is identified as a Certified Stroke Center by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO). Such a certification ensures that the most stringent standards of performance are met, especially when providing care in a potentially life-threatening situation such as stroke.
National Institute of Neurological Disorders and Stroke
American Stroke Association (A Division of the American Heart Association)
National Stroke Association
Joint Commission on Accreditation of Healthcare Organizations/Primary Stroke Center Certification
Heuschmann PU, Kolominsky-Rabas PL, Roether J, et al. Predictors of in-hospital mortality in patients with acute ischemic stroke treated with thrombolytic therapy. Journal of the American Medical Association. 2004;292(15):1831-1838.
Last reviewed Oct 22, 2004 by ]]>Richard Glickman-Simon, MD]]>
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