RESUMO
Background and Purpose- The aims of this study were to investigate the effect of an intervention to unblind data on r-tPA (recombinant tissue-type plasminogen activator) administration and sharing data with chief executive officers of participating hospitals, on r-tPA administration rates postintervention and on potential healthcare cost savings implemented at 26 Southeast Texas Regional Advisory Council hospitals. Methods- Retrospective analysis of prospective data on thrombolytic therapy from 26 Southeast Texas Regional Advisory Council hospitals, collected between April 2014 and June 2016. The control (blinded) period (Q2-2014 to Q2-2015) was followed by unblinding (Q3-2015). Results- Intervention was associated with 21.1% increase in r-tPA administration rates, with 38.5% increase in r-tPA administration with door-to-needle time ≤60 minutes. An absolute increase in r-tPA administration of 2.1% was seen with an average lifetime cost savings of $3.6 million. Conclusions- Transparent regional data sharing was associated with improved r-tPA administration and healthcare cost savings.
Assuntos
Isquemia Encefálica/tratamento farmacológico , Acidente Vascular Cerebral/tratamento farmacológico , Terapia Trombolítica/métodos , Terapia Trombolítica/normas , Tempo para o Tratamento/normas , Ativador de Plasminogênio Tecidual/administração & dosagem , Idoso , Isquemia Encefálica/economia , Isquemia Encefálica/epidemiologia , Redução de Custos/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Estudos Retrospectivos , Método Simples-Cego , Acidente Vascular Cerebral/economia , Acidente Vascular Cerebral/epidemiologia , Texas/epidemiologia , Terapia Trombolítica/economia , Tempo para o Tratamento/economia , Ativador de Plasminogênio Tecidual/economiaRESUMO
Approximately 750,000 US adults per year experience a stroke. On average, the annual risk for future ischemic stroke (secondary stroke) after an initial ischemic stroke or transient ischemic attack is approximately 3% to 4%. Cardioembolic strokes account for 20% to 25% of all strokes, with nonvalvular atrial fibrillation (NVAF) considered one of the main sources of embolism; this explains up to half of all cardioembolic strokes. We present the risk factors for stroke in NVAF, risk stratification, a diagnosis of NVAF, and treatment and prevention of stroke in NVAF. We reviewed the literature by performing a PubMed search of articles focusing on secondary stroke prevention in NVAF. This review examines the findings of major clinical trials and society guidelines for secondary stroke prevention in NVAF and presents a cost-effectiveness analysis.
