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JAMA · 2020
thrombolysis and in patients with hemorrhagic stroke cared for during the same time frame in these hospitals, suggesting that this finding was the result of more than just general improvements in stroke care and outcomes.4 The cumulative incidence curves showed that approximately 42% of the deaths or readmissions occurred within the first month.However, the curves for all-cause mortality, all-cause readmission, and the composite of mortality and readmission continued to separate throughout the 1-year period, suggesting the survival benefit was sustained for 1 year.The most plausible explanation is that better neurological function at discharge with earlier intravenous thrombolytic treatment, as demonstrated in a prior study, 5 enabled physical activity and healthier lifestyles, resulting in survival benefit and lower all-cause readmission through 1 year.Because of the high conformity with performance and quality measures, including most secondary stroke prevention and rehabilitation measures, among GWTG-Stroke participating hospitals as demonstrated in several previous studies, the current study did not examine the relationship between door-to-needle time and other stroke care metrics.We agree that further studies, including analyzing the association of door-to-needle times with functional outcomes, are warranted.