Patients with ischemic stroke have a greater likelihood of undergoing reperfusion therapy and having a subsequent lower 30-day mortality if they are treated at hospitals using telestroke, a real-time videoconference consultation solution that connects a remotely located stroke specialist with a patient and a healthcare 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 capacity (n=76,636). Study researchers also included a matched comparison cohort of patients with ischemic stroke who presented to hospitals without telestroke (n=76,636). Patients were matched based on sociodemographic, clinical characteristics, and hospital characteristics as well as the month and year of hospital admission.
The primary outcome of the study was the receipt of reperfusion treatment through thrombolysis with thrombectomy or alteplase. Other measures included the 30-day mortality rate and healthcare spending through 90 days from time of admission. Functional status, defined by the number of days spent living in the community following discharge, was also assessed.
Patients admitted to hospitals with telestroke capacity had significantly higher rates of reperfusion treatment compared with patients who presented at control centers (6.8% vs 6.0%, respectively; absolute difference, 0.78 percentage points; 95% CI, 0.54-1.03; P <.001). Additionally, patients who were admitted to telestroke hospitals also had lower 30-day mortality (13.1% vs 13.6%, respectively; difference, 0.50 percentage points; 95% CI, 0.17-0.83, P =.003).
No differences were observed between the groups in regard to time spent living in the community after discharge (difference, 0.25; 95% CI, -0.18 to 0.67; P =.26). There was also no difference in regard to institutional spending (difference, 36; 95% CI, -212 to 283; P =.31).
The increases in reperfusion receipt were largest in patients 85 years of age or older (risk ratio [RR], 1.18; 95% CI, 1.09-1.27), patients from rural residences (RR, 1.24; 95% CI, 1.17-1.32), admissions that occurred after 2015 (RR, 1.17; 95% CI, 1.11-1.23), and among hospitals treating fewer than 2 strokes per month (RR, 1.30; 95% CI, 1.19-1.43).
Study results for 30-day mortality were limited by the small effect size in the analysis as well as by the lack of any evident mortality benefit at 6 months.
While telestroke may be considered cost effective from Medicare’s perspective, study researchers emphasized that “it is important to emphasize that local hospitals must pay for telestroke capacity, and these payments are not captured in our data.”
Disclosure: Several study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.
Wilcock AD, Schwamm LH, Zubizarreta JR, et al. Reperfusion treatment and stroke outcomes in hospitals with telestroke capacity. JAMA Neurol. Published online March 1, 2021. doi:10.1001/jamaneurol.2021.0023