Trends in New Zealand stroke thrombolysis treatment rates

To describe trends in treatment delays and short-term outcome over the first 18 months of the New Zealand stroke thrombolysis register.

The National Stroke Network introduced a central register of all ischaemic stroke patients treated with intravenous alteplase on January 1, 2015. The aim was to increase thrombolysis treatment rates and drive improvements in safety.

From January 1, 2015 to June 30, 2016, alteplase was given to 623 patients [344 men, mean (range) age 70 (22-98) years] out of a total of 8,857 ischaemic and unspecified stroke patients, giving a thrombolysis rate of 7.0%. Between the first and second halves of the audit, there were more patients thrombolysed [350 of 4,456 (7.9%) versus 273 of 4,401 (6.8%); p=0.001] and more treated within 60 minutes of hospital arrival [137 of 325 (42%) versus 71 of 250 (28%), p=0.001]. Door-to-needle time reduced from 77 minutes to 64 minutes (p=0.002) and the onset-to-treatment reduced from 162 minutes to 140 minutes (p=0.070). Rates of symptomatic intracranial haemorrhage (4.3% patients) and survival at day seven (93%) were stable.

There have been improvements in stroke thrombolysis rates and treatment delays in New Zealand hospitals since the institution of the National Stroke Network thrombolysis register. The Network will continue to adjust key performance indicators, and stroke thrombolysis targets for individual DHBs have been increased to 8% for 2017 and 10% for 2018.