Factors associated with low rate of intravenous thrombolysis in Korea

초록

Background & Objective: Recently, the rate of intravenous thrombolysis (IVT) in patients with acute ischemic stroke has been declining in Korea. This study aimed to investigate the factors affecting the IVT implementation rate. Methods: This study analyzed the data of 28,800 patients admitted in 248 hospitals which participated in the 8th acute stroke quality assessment by Health Insurance Review and Assessment Service. Among them, 124 hospitals with 3 or more IVTs performed for 6 months were included. The IVT rates of individual hospitals were divided into quartiles (>=12.2%, 8.812.1%, 6.5-8.7%, <6.4%), and the characteristics of each group were compared. Number of specialists, 24-hour IVT availability, EVT implementation and accreditation of stroke center were additionally obtained by telephone interview in each medical institution. Results: The mean IVT rate of 124 hospitals was 9.75+/-4.71%. Most hospitals (119/124, 96.0%) responded that a 24-hour stroke-ready service for IVT was possible. The median door-toimaging time was 13.1 minutes, 13.3 minutes, 16.5 minutes, and 15.3 minutes for each quartile. Door-to-needle time was not statistically different: 54.4 minutes, 46.4 minutes, 51.6 minutes, and 50.2 minutes. The higher the IVT implementation rate, the higher the EVT implementation rate: 11.9%, 8.0%, 7.5%, and 6.8%. The ambulance use rate was significantly lower in the hospitals with lower IVT implementation rate: 64.2%, 61.3%, 57.4%, and 56.1%. The onset-to-visit time was also delayed in those hospitals: 3.2 hours, 4.0 hours, 5.1 hours, and 5.4 hours. Conclusions: Hospitals with low IVT rates had a lower rate of ambulance use and a longer hospital visit time from stroke onset. Unimproved patients’ recognition and the poor network with ambulance system may be important causes of recent declining IVT rate in Korea.