Temporal trends in acute stroke management.

The benefit of intravenous recombinant tissue-type plasminogen activator (rt-PA) for the treatment of acute ischemic stroke is well established.1,2 Unfortunately, the rates of rt-PA use among US patients with ischemic stroke remain quite low. Previously, our group published the rate of rt-PA use among ischemic stroke patients within the large Premier database, which is a 15% sampling of US hospitals that cross-references drug use with administrative data. The rate of rt-PA use was extremely low and did not increase from 2001 to 2004.3 This was despite rt-PA being approved for use in the US since 1996. More recently, we found that the rates of rt-PA have begun to slowly increase from 1.4% in fiscal year (FY) 2001 to 4.5% in FY 2009 (Figure 1).4 The timing of this increase seemed to coincide with primary stroke center certification by the Joint Commission in the United States in 2004, although this is only an association rather than definitive causality. Rates of rt-PA use did not seem to be affected by increased reimbursement given to hospitals for care of rt-PA–treated patients (instituted in 2006), as we had originally hypothesized. Figure 1. National estimates of recombinant tissue-type plasminogen activator (rt-PA) use in the United States. To explore the impact further of …