The Source for Neurovascular News and Education

September 17, 2019

Despite the encouraging trends, only a minority of patients receive this type of care, the authors note.

 

 

Over the last several years, outcomes for patients in the United States undergoing endovascular therapy for acute ischemic stroke have improved while mean costs and length of stay have declined, according to a study published online May 20, 2019, ahead of print in Stroke.

 

“This is a cross section and a reflection of what’s been happening in the real world in terms of patient claims and data,” lead author Ansaar T. Rai, MD (West Virginia University, Morgantown, WV), told Neurovascular Exchange. The time frame of the study—2011 to 2017—overlaps when clinical trials in 2015 began showing the efficacy of endovascular therapy, which allows for a look at how these data have translated into improved care, he noted.

 

Rai et al conducted a retrospective, observational study of acute ischemic stroke patients who underwent endovascular therapy during that 7-year period. They used the Premier Healthcare Database, a nationally representative database of more than 700 hospitals categorized based on bed size, geographic region, location (urban/ rural), and teaching status, to identify 505,824 acute ischemic stroke patients. Among these patients 11,811 (2.3%) were treated using endovascular therapy.

 

From 2011 to 2017, the percentage of patients who underwent endovascular therapy who were discharged home increased and their mortality decreased. There was also a reduction in the mean length of hospital stay and in total index admission costs.

 

Changes in Outcomes of Endovascular Therapy From 2011 to 2017

 

2011

2017

P Value

Discharge to Home

17.7%

29.6%

< 0.01

Mortality

21.6%

12.8%

< 0.01

Mean Length of Hospital Stay, days

11.7

8.7

< 0.01

Mean Index Hospital Costs, USD

$50,516.50

$42,026.90

< 0.01

 

There is “clearly a distinct and significant trend towards better outcomes over the time period of endovascular therapy,” said Rai. There is also significant cost savings, “which is important for hospitals and institutions and legislative bodies.”

 

Data Highlight Advances, but Also Care Gaps

 

Rai and colleagues say these gains may be a result of better techniques and patient selection. They also note that despite the fact that patients treated in recent years were older and sicker than those treated in 2011, “we found that outcomes still improved.”

 

These kinds of data, said Rai, can influence several aspects of systems of care. For instance, they highlight the need to focus on increasing awareness among the public about the early symptoms of stroke to encourage getting to a hospital as soon as possible. They also inform emergency medical services about the importance of immediately transporting patients with symptoms of acute ischemic stroke to an endovascular-capable institution, even if another hospital is closer. At the legislative level, these data can be used to inform mandates that patients with acute ischemic stroke be transferred to endovascular-capable centers and that reimbursement be tied to efficient transfer.

 

Despite the  positive shifts in clinical and economic outcomes, Rai and colleagues point out that there is still a significant morbidity and mortality burden for patients with acute ischemic stroke. In 2017, for example, inpatient mortality was > 10% and approximately 50% of patients were discharged to a long-term care facility.

 

“There is still a minority of patients who are actually getting treated [with] endovascular therapy,” added Rai. “We hope that data of this kind can help ignite systems of care and serve as an impetus to improve that.”

 




Source:

Rai AT, Crivera C, Kalsekar I, et al. Endovascular stroke therapy trends from 2011 to 2017 show significant improvement in clinical and economic outcomes. Stroke. 2019;Epub ahead of print.

 

Disclosures:

Rai reports consulting for Stryker Neurovascular and Cerenovus.