Patients with ischemic stroke are more likely to undergo reperfusion therapy and subsequently have lower 30-day mortality when treated in hospitals with Telestroke, a real-time videoconferencing consultation solution that a remote stroke specialist can with a patient and a healthcare link provider, according to a study in JAMA Neurology.
This study included traditional Medicare beneficiaries with acute ischemic stroke (mean age 78.8 years) who presented to hospitals with telestroke capability (n = 76,636). Study researchers also included a matching comparative cohort of ischemic stroke patients who presented to hospitals without telestroke (n = 76,636). Patients were matched based on socio-demographic, clinical, and hospital characteristics, and the month and year of hospitalization.
The primary outcome of the study was receipt of reperfusion treatment by thrombolysis with thrombectomy or alteplase. Other measures included the 30-day mortality rate and health expenditure up to 90 days from the time of admission. Functional status, defined by the number of days spent in the ward after discharge, was also assessed.
Patients admitted to hospitals with telestroke capacity had significantly higher reperfusion rates than patients who presented to control centers (6.8% versus 6.0%; absolute difference 0.78 percentage points; 95% CI 0.54-1 , 03; P <0.001)). Additionally, patients admitted to telestroke hospitals had lower 30-day mortality (13.1% versus 13.6%; difference 0.50 percentage points; 95% CI 0.17-0.83, P = 0.003 ).
No differences between the groups were observed in terms of time spent in the ward after discharge (difference 0.25; 95% CI, -0.18 to 0.67; P = 0.26). There was also no difference in institutional spending (difference 36; 95% CI -212 to 283; P = 0.31).
The increase in reperfusion reception was greatest in patients aged 85 and over (risk ratio) [RR]1.18; 95% CI, 1.09-1.27), patients from rural dormitories (RR, 1.24; 95% CI, 1.17-1.32), admissions after 2015 (RR, 1.17; 95% CI , 1.11-1.23) and less than 2 strokes per month among treating hospitals (RR 1.30; 95% CI 1.19-1.43).
The study results for 30-day mortality were limited by the small effect size in the analysis and the lack of an apparent mortality benefit at 6 months.
While Telestroke can be considered cost-effective from a Medicare perspective, the study’s researchers stressed that “it is important to emphasize that local hospitals must pay for telestroke capacity and that these payments are not recorded in our data.”
Disclosure: Several authors of the study have stated that they are part of the pharmaceutical industry. For a full list of the authors’ information, see the original reference.
reference
Wilcock AD, Sponge LH, Zubizarreta JR, et al. Reperfusion treatment and stroke outcomes in telestroke hospitals. JAMA Neurol. Published online March 1, 2021. doi: 10.1001 / jamaneurol.2021.0023
