United States trends in thrombolysis for older adults with acute ischemic stroke

• We investigated trends in thrombolysis use in older adults for ischemic stroke.
• Data from the Nationwide Inpatient Sample (NIS) from 2005 to 2010 were queried.
• Thrombolysis increased 3-fold the largest increase among the oldest patients (≥85).
• No thrombolysis-related change in ICH or in-hospital mortality over time.
• Thrombolysis rate increase primarily limited to urban/high volume hospitals.

ObjectiveThrombolysis for ischemic stroke has been increasing in the United States. We sought to investigate recent trends in thrombolysis use in older adults.MethodsA retrospective, observational analysis of hospitalization data from the Nationwide Inpatient Sample (NIS) in 2005–2010 was performed. Older adults (≥65 years) admitted with a primary diagnosis of acute ischemic stroke were included. Trends in the population-based rates of thrombolysis and outcomes from the NIS were evaluated using the Cochran–Armitage test.ResultsThrombolysis in older adult stroke patients increased from 1.7% to 5.4% (2005–2010; trend P < 0.001). Large increases were observed among urban patients, urban hospitals, and high volume facilities. Individuals ≥85 years were less likely to receive thrombolysis than younger ages throughout the study period, although there was an increase from an odds ratio of 0.50 (95% CI: 0.44–0.57) to 0.75 (95% CI: 0.69–0.81) from 2005–2006 to 2009–2010 when compared to 65–74 year olds. For those receiving thrombolysis, no change was observed in intracerebral hemorrhage over time. In-hospital mortality rates did not change significantly over the study period for age subgroups and length of stay declined from 2005 to 2010 for the thrombolysis group (7.6 vs 7.0 days; trend P < 0.001).ConclusionsRates of thrombolysis in older adults progressively increased, especially in the oldest old. Increases were largely driven by urban and high volume hospitals.