Abstract Details

Title Inpatient Telestroke Coverage Improves Guideline-Based Secondary Stroke Prevention: Results from the TELECAST Trial

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) P7 - Poster Session 7 (5:30 PM-6:30 PM)

Poster/Presentation
Number 4-012

Objective The TELECAST trial (NCT03672890) prospectively examined the impact of a 24-7 telestroke specialist service dedicated to inpatient acute stroke care spanning admission to discharge. The primary outcomes of TELECAST are presented separately (abstract 3928).

Background Preliminary results of the TELECAST trial demonstrated improvement in guideline-based delivery of acute stroke care following the implementation of a 24-7 inpatient telestroke service at a spoke hospital without prior access to stroke specialists. Improvement was specifically noted in secondary stroke prevention (SSP) metrics; we present these subgroup findings in full detail.

Design/Methods AHA stroke guidelines were used to determine SSP metrics for acute stroke care, including: antiplatelet within 48 hours, anticoagulation, statin, antihypertensives, diabetes medications, and symptomatic carotid revascularization. Adherence to SSP guidelines were studied for stroke patients admitted pre-telestroke (July 1, 2016-June 30, 2018) and post-telestroke intervention (July 1, 2018-June 30, 2019). Chi-squared tests were utilized to assess for statistical significance (α=0.05). Statistical analysis was performed using STATA 15.0.

Results 267 patients were included in the pre-telestroke intervention cohort and 284 in the post-telestroke intervention cohort. Following institution of a comprehensive inpatient telestroke service, overall adherence to SSP guideline-based metrics improved (95.6% vs 98.0%, p<0.01). Antiplatelet administration within 48 hours was the only individual SSP metric that was improved with inpatient telestroke (89.3% vs. 97.0%, p=0.02). Symptomatic carotid revascularization was numerically higher in the telestroke cohort (66% vs 100%, p=0.12), however, these numbers were low and underpowered to detect a difference.

Conclusions SSP improved following inpatient telestroke intervention. Individually, antiplatelet within 48 hours was improved, which may be due to more rapid diagnosis and treatment through telestroke. Additionally, symptomatic carotid revascularization had a trend towards improvement, but overall numbers were low. Other SSP metrics (anticoagulation, statin, antihypertensives, and diabetes medications) were equally well managed prior to telestroke intervention.

Authors/Disclosures
Amelia Solei, NP PRESENTER	Mrs. Solei has nothing to disclose.
Kathryn Bard, PA	Ms. Bard has nothing to disclose.
Matthew K. Ronck, MD (SSM Health)	No disclosure on file
Eric Jaton, MD	No disclosure on file
	No disclosure on file
Monica Ngo, MD (University of Minnesota Medical School - Twin Cities)	Dr. Ngo has nothing to disclose.
Apameh Salari, MD	Dr. Salari has nothing to disclose.
Sarah A. Engkjer, RN (Minnesota Epilepsy Group)	No disclosure on file
Andrew J. Zhang, MD (Cleveland Clinic)	Dr. Zhang has nothing to disclose.
Jae H. Kim, MD (University of Minnesota)	No disclosure on file
Christine E. Yeager, MD (Rush University Medical Center)	Dr. Yeager has nothing to disclose.
Oladi S. Bentho, MD (University of Minnesota)	Dr. Bentho has nothing to disclose.
Benjamin R. Miller, MD (University of Minnesota)	The institution of Dr. Miller has received research support from StrokeNET.
Christopher Streib, MD (Department of Neurology)	Dr. Streib has nothing to disclose.

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Abstract Details