Time to Acute Treatment in Intracerebral Hemorrhage Lags Significantly Behind Ischemic Stroke: A Multicenter, Observational Retrospective Study.

Abstract

Background: Time-to-treatment goals for acute ischemic stroke (AIS) have substantially improved outcomes, yet similar metrics have not been studied in patients with intracerebral hemorrhage (ICH), where mortality rates are much higher.

Methods: Multicenter, observational retrospective study of patients with ICH and AIS between January 1, 2017, and December 31, 2022, in 11 comprehensive stroke centers across the United States participating in Get With The Guidelines. We included patients with ICH who received antihypertensive therapy and anticoagulation reversal, and patients with AIS requiring intravenous thrombolytic and mechanical thrombectomy. The coprimary outcomes included (1) time-to-treatment and (2) the percentage of patients meeting current national time interval goals. Multivariable logistic regression models controlling for age, sex, race and ethnicity, time to arrival, National Institutes of Health Stroke Scale score, arrival systolic blood pressure, and admission international normalized ratio were constructed to assess the likelihood of patients with ICH being treated within goal compared with patients with AIS. Multivariable logistic regression models were constructed to assess the impact of treatment time on mortality or discharge disposition in patients with ICH.

Results: A total of 28 180 patients were identified, of which 7003 patients were included: n=1972 ICH (mean age, 67; 43% female) and n=5031 AIS (mean age, 69; 49% female). The median door-to-first medication was 52 (28-157) minutes for patients with ICH and 42 (30-63) minutes for patients with AIS (P<0.001). Fifty-three percent of patients with ICH received antihypertensive medications in ≤60 minutes from arrival compared with 74% of patients with AIS who received intravenous thrombolytic ≤60 minutes (P<0.001). Thirty-seven percent of patients with ICH received anticoagulation reversal ≤90 minutes from arrival compared with 47% of patients with AIS with door-to-puncture times ≤90 minutes (P<0.001). The adjusted odds of timely treatment in patients with ICH compared with patients with AIS are less than three-fourths (adjusted odds ratio, 0.74 [95% CI, 0.61-0.89]; P<0.01). Patients with ICH who received antihypertensive treatment ≤60 minutes from arrival had a higher likelihood of discharge to home or acute rehab unit (adjusted odds ratio, 7.48 [95% CI, 1.99-28.09]; P<0.01) compared with those treated in >60 minutes.

Conclusions: Time-to-treatment for patients with ICH is significantly longer than for patients with AIS. Faster antihypertensive treatment times are associated with better discharge outcomes in patients with ICH.