Testing the Presumption of Consent to Emergency Thrombolysis for Stroke (S35.005)

OBJECTIVE: To investigate the empirical basis of the presumption to consent for emergency thrombolysis for ischemic stroke. BACKGROUND: Recently, the AAN and AHA/ASA have endorsed emergency thrombolysis for ischemic stroke when consent cannot be obtained, on the presumption that reasonable people would consent to treatment in such circumstances. This presumption has been controversial because, unlike other interventions for which emergency consent has been presumed, thrombolysis is not life-preserving. DESIGN/METHODS: We elicited preferences regarding emergency treatment in a nationally representative sample of 2,154 older adults. Participants were presented vignettes in which they had either suffered an acute ischemic stroke and could be treated with thrombolysis, or had suffered a sudden cardiac arrest and could be treated with cardiopulmonary resuscitation (CPR). Participants were then asked either (1) whether they would want the intervention, or (2) whether they would want to be given the intervention even if informed consent could not be obtained. RESULTS: Overall, 76.2% of older adults would want thrombolysis for stroke, while 75.9% would want CPR for cardiac arrest. If informed consent could not be obtained, the desirability of thrombolysis was unaffected (78.1%), while a greater proportion wanted treatment with CPR (83.6%). Female gender, black race, divorced or never married marital status, lower income, lower educational attainment and lack of a healthcare advance directive were associated with declining thrombolysis. Age, poor physical health, possession of a healthcare advance directive, and preference for independence over longevity were associated with declining CPR. CONCLUSIONS: The proportion of older adults who would want emergency thrombolysis is comparable to the proportion who would want emergency CPR, and is unaffected by the inability to obtain informed consent. Study Supported by: National Institute on Aging (K23AG043553), National Center for Advancing Translational Sciences (KL2TR000143), and the American Brain Foundation Clinical Research Training Fellowship Program. Data collection was provided by Time-sharing Experiments in the Social Sciences, NSF Grant 0818839. Disclosure: Dr. Chiong has nothing to disclose. Dr. Kim has received research support from SanBio, Inc. Dr. Huang has nothing to disclose. Dr. Farahany has nothing to disclose. Dr. Josephson has received personal compensation in an editorial capacity for Annals of Neurology and Journal Watch Neurology.