Dissemination of thrombolysis for acute ischemic stroke across a nation: experiences from the Swedish stroke register, 2003 to 2008.

Abstract:

BACKGROUND AND PURPOSE:We used Riks-Stroke, the Swedish Stroke Register, to explore how thrombolysis has been disseminated in Swedish hospitals since it was approved in 2003. METHODS:All 78 hospitals in Sweden admitting patients with acute stroke participate in Riks-Stroke. Between 2003 and 2008, 72 033 adult patients were hospitalized for acute ischemic stroke. We analyzed thrombolysis use by region, patient characteristics, and stroke service settings. RESULTS:Nationwide, the use of thrombolysis increased from 0.9% in 2003 to 6.6% in 2008. There were marked regional differences in the dissemination of thrombolysis, but these gaps narrowed over time. Nonuniversity hospitals reached treatment levels similar to university settings, although with a 2- to 3-year delay. Symptomatic intracranial hemorrhage remained at the 3% to 9% level without an apparent time trend during dissemination. Independent predictors of higher thrombolysis use included younger age, male sex, not living alone, and no history of stroke or diabetes. In 2008, patients admitted to a stroke unit were 5 times more likely to receive thrombolysis than those admitted to general wards. CONCLUSIONS:Nationwide implementation of thrombolysis has been slow but has accelerated mainly due to increased access outside university hospitals. The increased use has been achieved safely, but access has been unequal.

journal_name

Stroke

journal_title

Stroke

authors

Eriksson M,Jonsson F,Appelros P,Asberg KH,Norrving B,Stegmayr B,Terént A,Asplund K,Riks-Stroke Collaboration.

doi

10.1161/STROKEAHA.109.577106

subject

Has Abstract

pub_date

2010-06-01 00:00:00

pages

1115-22

issue

6

eissn

0039-2499

issn

1524-4628

pii

STROKEAHA.109.577106

journal_volume

41

pub_type

杂志文章,多中心研究

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