A study, published in Age and Ageing describes the findings from the Stroke Improvement National Audit Programme (SINAP), which collects data on the quality of care stroke patients receive during their first 3 days following admission to hospital. Currently, 107 hospitals in England take part in the audit.
The aim of the study was to identify whether older patients (age >80 years) were being treated with thrombolysis (clot-busting treatment) for stroke and to see what the outcomes were compared with younger people. This study is important because until very recently there were only small numbers of older people included in the randomised controlled trials of thrombolysis treatment.
This study comprised 37,151 stroke patients in England and the main findings were:
- Almost one in five patients being treated with thrombolysis from Stroke in SINAP are over 80 years old.
- Older patients were treated with thrombolysis as quickly as younger patients. This is important because the treatment needs to be given as quickly as possible for it to be effective. Older people were also at no higher risk of thrombolysis complications, (such as bleed in the brain) than younger people.
- Older people are generally at a higher risk of death following stroke than younger people.
These findings show that thrombolysis for stroke is now being carried out frequently and safely in older patients with stroke in hospitals that participate in SINAP. Older people are at a higher risk of death after stroke than younger people and further research is needed to find ways of reducing mortality in older people following a stroke.
Earlier this year, the IST3 trial (published in The Lancet), which was a randomised controlled trial, provided evidence that thrombolysis was safe and effective in older people. This SINAP study used data from ‘real’ clinical practice about who receives the treatment and the outcomes. The two together provide a complete picture: that thrombolysis in older people is not associated with higher risk compared with younger people.
Thrombolysis is not currently licensed for treatment in older people because of a concern of increased side effects, such as bleeding in the brain, but the study and the IST3 trial indicate that this is no longer the case. There should now be a change in practice with patients over 80 routinely receiving clot-busting treatment. The national clinical guideline for stroke recommends that patients (regardless of age or stroke severity) for whom treatment can be started within three hours, should be considered for thrombolysis. The guideline is now available as an app.
The latest SINAP figures for July – September 2012 are now available. The progress of hospitals across England can be viewed on the SINAP latest results page. SINAP is managed by the Clinical Effectiveness and Evaluation Unit at the Royal College of Physicians and funded by the Healthcare Quality Improvement Partnership. The authors of the study would like to thank all staff in the 107 hospitals involved.
- The article Stroke thrombolysis in England: an age stratified analysis of practice and outcome is available from Age and Ageing, an international journal publishing peer reviewed articles and reviews on geriatric medicine and gerontology.
- To access the guideline app:
- The IST3 trial article can be found here: www.thelancet.com/journals/lancet/article/PIIS0140-6736(12)60768-5/abstract