TOPLINE:

Treatment delays were significantly longer for adult patients with intracerebral hemorrhage (ICH) than for those with acute ischemic stroke (AIS), new research showed. Additionally, initiating antihypertensive therapy within 60 minutes increased the odds of discharge by more than sevenfold in patients with ICH.

METHODOLOGY:

• Researchers conducted a multicenter, observational retrospective study in 11 urban Comprehensive Stroke Centers across the US between 2017 and 2022.
• They analyzed data for more than 7000 adults with ICH (mean age, 67 years; 43% women) or AIS (mean age, 69 years; 49% women).
• Primary outcomes were time from hospital arrival to first treatment, defined as initiation of either a blood pressure-lowering agent or an anticoagulation reversal agent for eligible patients with ICH vs intravenous thrombolysis (IVT) administration or arterial puncture time for eligible patients with AIS, and percentage of patients meeting current national time-interval goals.
• The analysis was controlled for age, sex, race, ethnicity, and clinical variables.

TAKEAWAY:

• The median time from hospital arrival to first medication was significantly longer for patients with ICH than for those with AIS (52 minutes vs 42 minutes, respectively; P < .001), as was the time to anticoagulation reversal in patients with ICH vs arterial puncture in those with AIS (131 min vs 93 min; P < .001).
• The likelihood of receiving timely treatment was significantly lower for patients with ICH than for those with AIS (adjusted odds ratio [aOR], 0.74; P < .01).
• The percentage of patients who met time-interval goals was also significantly lower among those with ICH than among those with AIS (P < .001). Patients with ICH and systolic blood pressure above 150 mm Hg at admission who received antihypertensive treatment within 60 minutes of arrival had a significantly greater likelihood of being discharged to home or an acute rehabilitation unit than those treated after 60 minutes (aOR, 7.5; P < .01).
• Those with ICH who received reversal agents within 90 minutes of arrival had lower likelihood of mortality than those who received delayed treatment (aOR, 0.5; P = .046).

IN PRACTICE:

“The only plausible explanation for delays in ICH treatment compared with AIS treatment is that medical and stroke teams are attuned and trained to meet specific targets for AIS but not for ICH,” the investigators wrote.

“The success of timely administration of IVT should be easily replicated in patients with ICH since antihypertensive agents are equally accessible and, in fact, more commonly used in emergency departments than IVT,” they added.

SOURCE:

The study was led by Kara R. Melmed, MD, New York University Grossman School of Medicine, New York City. It was published online on September 3 in Stroke.

LIMITATIONS:

The study was limited by missing data for certain variables and included only academic Comprehensive Stroke Centers, which may not represent all hospitals and patient populations. Additionally, the exclusion of transferred patients and in-hospital stroke events may have created selection bias. The lack of data on early withdrawal of life-sustaining treatment or team perceptions of poor outcomes may have influenced treatment timing decisions. Moreover, the study did not assess long‐term functional outcomes, limiting conclusions about disability.

DISCLOSURES:

Several investigators reported having financial ties with various organizations, including pharmaceutical companies, and one reported having a pending patent on stroke wearables. Full details are provided in the original article.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.