Stroke Treatment: 1 Minute = 1.8 Healthy Days

For survivors of stroke, time is of essence.

Tissue plasminogen activator drugs should be given within 4.5 hours of symptom onset to treat ischemic stroke, according to the American Heart Association (AHA). But a new study shows how even the shortest delays in treatment may significantly impact disability-free life for post-stroke survivors.
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“‘Save a minute, save a day’ is the message from our study,” said Atte Meretoja, MD, PhD, associate professor of neurology, University of Melbourne, Australia, in an AHA press release. Meretoja and colleagues conducted an observational prospective study that sought to quantify lifetime benefits gained from faster treatment in 2258 stroke patients in Australian and Finnish stroke centers. The study analyzed these patients according to age, sex, stroke severity (per the National Institutes of Health Stroke Scale [NIHSS], onset-to-treatment times, and 3-month modified Rankin Scale in daily clinical practice.

The results of the analysis showed that each minute of onset-to-treatment time saved, on average, 1.8 days of healthy life (95% prediction interval, 0.9-2.7). Although these benefits were observed across all groups, the greatest benefit was shown in younger adults with more severe strokes; and women gained slightly more time than men over their longer lifetimes:

  • Among the oldest old (aged 80 years and older) with an NIHSS score of 20, each minute provided 0.6 days of healthy life;
  • Among the oldest old with an NIHSS score of 4, each minute provided 0.9 days of healthy life;
  • Among middle-aged adults (aged 50 years and older) with an NIHSS score of 3, each minute provided 2.7 days of healthy life;
  • And among middle-aged adults (aged 50 years and older) with an NIHSS score of 20, each minute provided 3.5 days of healthy life.

The investigators concluded that across the whole cohort, each 15-minute decrease in treatment delay provided an average of 1 month of disability-free life.

“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.” said Meretoja, adding that the study’s findings are generalizable to the U.S. population. “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.”

- Allison Musante, ELS

Reference

Meretoga A, Keshtkaran M, Saver JL, et al. Stroke thrombolysis. Stroke. Published online ahead of print March 13, 2014.