Abstract
Background:
Patients aged ≥80 years are often underrepresented in stroke trials. Observational studies have shown that older patients have worse outcomes compared with younger patients, but outcomes in patients aged ≥80 years treated with intravenous (IV)-alteplase specifically through telestroke (TS) have not been studied.
Aim:
To compare clinical and safety outcomes in stroke patients aged ≥80 and 60–79 years treated with IV-alteplase via TS.
Methods:
The Medical University of South Carolina TS database was analyzed to identify IV-alteplase-treated patients aged 60–79 and ≥80 years between January 2015 and March 2018. Baseline demographics and TS-specific variables were compared. Clinical outcomes were assessed using the 90-day modified Rankin Scale (mRS). Safety outcomes were evaluated by comparing symptomatic intracranial hemorrhage (sICH). Multivariate logistic regression analysis was performed to determine odds ratio (OR) for good outcome (mRS 0–2) in the older age group at 90 days.
Results:
IV-alteplase was used in 151 patients in ≥80 years age group and 273 patients in 60–79 years age group. The older age group had more women and a higher National Institutes of Health Stroke Scale. The mean “ED-door-to-TS-consultant-login” time was shorter (21.6 min vs. 25.6 min; p = 0.048), but “TS-consultant-login-to-alteplase” time was longer (22.1 min vs. 19.3 min; p = 0.01) in the older age group. No difference was noted in eventual “door-to-needle” time. The older age group had fewer good outcomes (39.1% vs. 74%; p = 0.001) and more deaths (38% vs. 14%; p = 0.001) at 90 days. The sICH rates were similar in the two groups. The OR for good outcome in ≥80 years age group was 0.20 (95% CI: 0.12–0.34) after controlling for baseline variables.
Conclusions:
Stroke patients aged ≥80 years treated via TS have similar post-thrombolysis hemorrhage rates but worse clinical outcomes compared with patients aged 60–79 years.
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