Abstract Body: Introduction: Contrary to improved mortality in acute ischemic stroke (AIS), mortality of intracerebral hemorrhage (ICH) remains high. This may be attributable to delays in acute treatments for ICH patients. We aimed to establish the current time to treatment in ICH patients across the U.S., compare this to AIS patients, and assess the impact of treatment times on outcomes.

Methods: This multicenter cross-sectional retrospective study pooled ICH and AIS patients aged ≥ 18 years with admission between January 1, 2017 to December 31, 2022 to acute care hospitals nationwide participating in the Get with the Guidelines-Stroke quality improvement registry. Baseline demographics, clinical variables including time to treatment (antihypertensive agent, hemostatic agent, neurosurgery, thrombolytic or thrombectomy) were abstracted and compared using classical statistics. Logistic regression and time dependent Cox analysis were performed to assess the impact of time to treatment on discharge disposition and mortality in ICH patients.

Results: We identified 3,344 ICH patients (mean (standard deviation) age 66(16) years, 43% female, and 5,386 AIS patients (mean (SD) 69(15) years, 48 % female) across eleven hospital systems. Median door to CT time was significantly longer in ICH compared with AIS patients at 26[12-69] vs14[8-25] minutes.
Median NIHSS for ICH patients was significantly higher (13[5-25]) than AIS patients (10[4-18]). In ICH patients, median[IQR] arrival systolic blood pressure (SBP) was 179[160-205] mm HG and anticoagulation (AC) use was documented in 13.8%. Door to first treatment was 67[32-246] minutes for ICH patients and 55[35-114] minutes for AIS patients. ICH patients had a greater length of stay (7[3-14] days vs 5[2-9] days) and a higher median discharge mRS (4[3-6] vs 3[1-4]), p < 0.01 for all). Controlling for age, gender, race/ethnicity, NIHSS score, door to ED evaluation, prior AC use, arrival SBP and admission INR, the 1,047(31%) patients who were treated within 60 minutes from arrival had a higher likelihood of discharge to home or acute rehab; OR 1.73 95% CI (1.01-2.97). Time to antihypertensive treatment was a significant predictor of time to death with a hazard ratio (HR) of 1.22(1.03-1.45, p= 0.02).

Conclusion: Compared to AIS patients, time to treatment for ICH patients is generally longer. Faster treatment times were associated with better discharge outcomes. These findings emphasize the need for improved time metrics in ICH care.