Study Finds Gaps in Stroke Transfers Causes Worse Outcomes in Patients

A study suggests that “gaps in the nation’s stroke transfer system are drastically reducing survivors’ chances of receiving critical treatment and increasing the likelihood that they will leave the hospital with a disability.”

About a third of ischemic stroke survivors are eligible for endovascular thrombectomy, but more than 40% of people who receive endovascular therapy are “initially seen at hospitals that don’t offer the treatment,” necessitating a transfer. The vast majority of stroke patients face “prolonged time to transfer – a process known as door-in-door-out – which reduces their chance of receiving endovascular therapy and increases their chances of leaving the hospital with significant disability.”

A study published in The Lancet Neurology focused on over 20,000 patients with acute ischemic stroke, and found that “just 26% of transfers occurred within 90 minutes, the maximum time recommended by the American Heart Association. The likelihood of a patient receiving endovascular therapy declined steeply as transfer time delays grew. Patients with transfer times between 91 minutes and three hours had 29% less chance of receiving a thrombectomy.” Stroke patients with longer door-in-door-out times had “more complications after treatment and a lower likelihood of being able to walk independently after leaving the hospital.”

An NIH-sponsored clinical trial is currently ongoing to determine if “an intervention to reduce door-in-door-out times at eight large health systems around the U.S. will improve functional outcomes for acute ischemic stroke patients undergoing thrombectomy.”