Implementation of regional Acute Stroke Care Map increases thrombolysis rates in urban areas of China: an interrupted time series analysis.

Abstract

Background: Stroke, a leading cause of global disability, where timely thrombolysis is crucial for favorable outcomes. Despite initiatives like Acute Stroke Care Maps (ASCaMs) in China aiming to improve care continuity and thrombolysis rates, the long-term effectiveness of these interventions in urban settings remains underexplored.

Methods: This retrospective cohort study investigates the role of the Shenyang ASCaM in improving the thrombolysis rate with tissue plasminogen activator within 4.5 hours of ischemic stroke onset in 30 hospitals. Using interrupted time series (ITS) analysis, it compares outcomes before and after ASCaM's implementation from April 2019 to December 2021. The ASCaM strategy, featuring EMS prenotification, rapid triage, and immediate neuroimaging, is assessed. Regression models, adjusted for patient demographics and clinical scores, evaluate the intervention's impact, controlling for potential confounders.

Results: In the study, 2676 patients were evaluated before the implementation of the Shenyang ASCaM, and 8277 patients were assessed during its implementation. Thrombolysis rates within the vital 4.5-hour window rose significantly from 59% before ASCaM to 72% during its implementation (P < .001), and door-to-needle time (DNT) decreased significantly by 12.269 minutes (P < .0001). Early neurological deterioration (END) incidents decreased significantly from 44% to 39.2% (adjusted OR = 0.820, P = .001), indicating improved stroke care efficiency and outcomes. ITS analysis showed a pre-implementation monthly decrease in thrombolysis rates of 0.95%, countered by a post-implementation immediate surge of 6.21% and a sustained improvement at a rate of 0.13% per month. Furthermore, Post-ASCaM, DNT reduced to 52.42 minutes, thrombolysis rates increased to 72.3%, and END incidence decreased (adjusted OR = 0.820, P = .001), indicating improved stroke care efficiency and outcomes.

Conclusion: Our findings confirm that China's ASCaMs significantly enhance thrombolysis rates and ensure care continuity in managing acute stroke, indicating their long-term effectiveness in urban settings. This contributes to global stroke care improvements, emphasizing the potential for wider application and further research on sustained interventions.