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. 2021 Mar;6(1):87-94.
doi: 10.1136/svn-2020-000332. Epub 2020 Sep 24.

Implementation of regional Acute Stroke Care Map increases thrombolysis rates for acute ischaemic stroke in Chinese urban area in only 3 months

Yi Sui  1 , Jianfeng Luo  2 , Chunyao Dong  1 , Liqiang Zheng  3 , Weijin Zhao  1 , Yao Zhang  1 , Ying Xian  4 , Huaguang Zheng  5 , Bernard Yan  6 , Mark Parsons  6 , Li Ren  1 , Ying Xiao  1 , Haoyue Zhu  1 , Lijie Ren  7 , Qi Fang  8 , Yi Yang  9 , Weidong Liu  10 , Bing Xu  11
Affiliations

Implementation of regional Acute Stroke Care Map increases thrombolysis rates for acute ischaemic stroke in Chinese urban area in only 3 months

Yi Sui et al. Stroke Vasc Neurol. 2021 Mar.

Abstract

Background: The rate of intravenous thrombolysis for acute ischaemic stroke remains low in China. We investigated whether the implementation of a citywide Acute Stroke Care Map (ASCaM) is associated with an improvement of acute stroke care quality in a Chinese urban area.

Methods: The ASCaM comprises 10 improvement strategies and has been implemented through a network consisting of 20 tertiary hospitals. We identified 7827 patients with ischaemic stroke admitted from April to October 2017, and 506 patients underwent thrombolysis were finally included for analysis.

Results: Compared with 'pre-ASCaM period', we observed an increased rate of administration of tissue plasminogen activator within 4.5 hours (65.4% vs 54.5%; adjusted OR, 1.724; 95% CI 1.21 to 2.45; p=0.003) during 'ASCaM period'. In multivariate analysis models, 'ASCaM period' was associated with a significant reduction in onset-to-door time (114.1±55.7 vs 135.7±58.4 min, p=0.0002) and onset-to-needle time (ONT) (169.2±58.1 vs 195.6±59.3 min, p<0.0001). Yet no change was found in door-to-needle time. Clinical outcomes such as symptomatic intracranial haemorrhage, favourable functional outcome (modified Rankin Scale ≤2) and in-hospital mortality remained unchanged.

Conclusion: The implementation of ASCaM was significantly associated with increased rates of intravenous thrombolysis and shorter ONT. The ASCaM may, in proof-of-principle, serve as a model to reduce treatment delay and increase thrombolysis rates in Chinese urban areas and possibly other highly populated Asian regions.

Keywords: stroke; thrombolysis.

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
Flowchart of the included study population. AIS, acute ischaemic stroke; ASCaM, Acute Stroke Care Map; tPA, tissue plasminogen activator.
Figure 2
Figure 2
Greater Shenyang Acute Stroke Care Map. The geographical locations of all 20 participating hospitals are displayed. The inset image is the greater Shenyang map illustrating individual administrative divisions. The figure was modified from https://en.wikipedia.org/wiki/Shenyang under licensing of CC0 1.0 universal public domain dedication.
See this image and copyright information in PMC

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