Abstract TP042: Improving Door-to-Needle Times for IV Thrombolysis in Iowa: Outcomes from the Mission: Lifeline Stroke Initiative

Introduction: Mission: Lifeline Stroke Iowa was a three-year, grant-funded initiative to enhance statewide stroke systems of care through data feedback, monthly learning collaboratives, annual workshops and conferences, and public awareness efforts. Fifty percent of Iowa hospitals, including all certified stroke centers, are using the American Heart Association (AHA) Get With The Guidelines®–Stroke (GWTG-Stroke) registry. These data were used to evaluate change in door-to-needle (DTN) times for IV thrombolytic therapy from 2022 to 2024. Methods: De-identified data were extracted from the GWTG-Stroke registry. Analyses compared baseline 2022 data with 2024 data for patients eligible for IV thrombolytics. Metrics included the percentage of patients achieving DTN times < 60 and < 45 minutes, the number of hospitals earning AHA Target: Stroke Honor Roll recognition ( > 75% of applicable patients DTN < 60 minutes), and descriptive statistics (mean, median, and standard deviation) for DTN times. Statistical analyses were preformed to evaluate temporal changes. Results: In 2022 and 2024, 5,480 and 5,899 stroke patients, respectively, were entered into Iowa’s GWTG-Stroke registry. Among eligible patients, the proportion receiving IV thrombolytics within 60 minutes increased from 71.6% to 74.6%, and within 45 minutes from 42.5% to 50.7%. Mean DTN time decreased from 57.1 to 53.5 minutes (SD −3.6), with regression analysis demonstrating a statistically significant 5.24 minute improvement by 2024 (p < 0.01). Hospitals achieving Target: Stroke Honor Roll recognition increased from 6 in 2022 to 14 in 2024. Conclusions: The Mission: Lifeline Iowa initiative was associated with measurable improvements in statewide DTN performance. Regular data feedback, monthly learning collaboratives, annual workshops and conferences, and public awareness efforts supported hospital engagement and performance improvement. A 5-minute statewide reduction in DTN times represents a clinically meaningful impact, as faster treatment translates into improved outcomes for stroke patients across Iowa.