Quantifying the Benefits of Faster Onset-to-Treatment Times for Thrombolysis

Anthony S. Kim, MD, MAS

When administering thrombolysis for acute ischemic stroke, each minute saved restores the equivalent of 1.8 days of disability-free life.

Intravenous thrombolysis is more effective when administered soon after symptom onset, yet in-hospital delays of 80 minutes are commonplace (Circulation 2011; 123:750). Previous studies have quantified the benefits of timely treatment as odds ratios, numbers needed to treat, or numbers of neurons saved. In this study, researchers developed a model to quantify the lifetime health benefits of faster treatment using a perhaps more tangible, patient-centered measure: the disability-adjusted life day. This summary measure incorporates the quantity of life benefits of averting premature death as well as the quality of life benefits of reducing disability over a lifetime. The researchers used data from a pooled analysis of thrombolysis trials to estimate the short-term impact of improved treatment times for a real-world spectrum of 2258 stroke patients from two large registries in Finland and Australia. The authors totaled these benefits over each patient's expected lifespan to derive the total number of disability-free life days restored by faster treatment.

Each minute of improvement in onset-to-treatment time restored the equivalent of 1.8 additional days of disability-free life (95% prediction interval, 0.9–2.7 days). Younger patients, women, and patients with severe strokes realized greater benefits from faster treatment. For example, young patients with severe strokes (age, 50; NIH stroke scale score, 20) gained 3.5 days of disability-free life per 1-minute improvement in onset-to-treatment time.

Citation(s):

Meretoja A et al. Stroke thrombolysis: Save a minute, save a day. Stroke 2014 Mar 13; [e-pub ahead of print].