Research presented at the American Stroke Association’s International Stroke Conference 2014 showed that although 81% of people in the United States lives within an hour’s drive of a hospital equipped to treat acute stroke, only 4% received tPA, a drug which can reduce disability if given within 3-4 hours of the first stroke symptom, and the only drug approved by the FDA to treat stroke.
Researchers reviewed the records of 370,000 Medicare stroke claims from 2011. (Annually in the United States, 800,000 people suffer from stroke.) The low percentage of patients receiving the recommended (and only) treatment for stroke is a significant impact to both the patient safety goal (because of the disability that could be avoided with proper treatment) and the patient services goal, because so many patients are not getting adequate treatment after a stroke.
There are many challenges involved in administering tPA within the recommended time frame. Administration is ideally done within 3-4 hours of the first stroke symptoms, but faster is better. As the study‘s lead author, Dr. Opeolu Adeoye, M.D., M.S. states, “Every 15-minute delay in getting treatment increases the odds of that patient not being able to go home.”
Although 4 out of 5 patients live within an hour’s drive of a designated stroke center, a hospital which is equipped to treat stroke (and not all hospitals are), that still leaves almost 20% who aren’t. The drug tPA can’t be administered before imaging confirms the stroke and that it is a non-bleeding-type stroke as administering tPA to patients suffering from a bleeding-type stroke can cause harm. Even after a patient arrives at a stroke center, delays in imaging and treatment could increase the time before tPA is administered to outside the window. The study also found that 60% of hospitals did not administer tPA to stroke victims, though it is the only recommended treatment for acute stroke.
Many potential solutions are being studied and implemented to reduce the risk of stroke after disability.
For patients: the best way to reduce the risk of disability from stroke is to prevent having a stroke in the first place. About 80% of strokes are preventable and due to risk factors, such as smoking or obesity. Maintaining a healthy lifestyle can reduce the risk of stroke. If you or a loved one suffers from a stroke, contact an ambulance, as the ambulance will be able to direct you to a designated stroke center. If you are driving yourself, it’s worth it to go to a designated stroke center, even if that means “bypassing another hospital that isn’t set up to deliver the necessary therapy, ” says Dr. Adeoye.
For paramedics: because paramedics tend to see most stroke patients before they get to a medical center, the search is on for a drug that could be administered prior to imaging (unlike tPA) so that stroke treatment could begin prior to arriving at a medical center. A study looked at administering intravenous magnesium in the ambulance, but found that it did not improve stroke-related disability. However, if another drug can be found that would, researchers are hopeful, as the median time for receiving the stroke treatment by ambulance was 45 minutes after symptoms began, and 74% of patients began treatment within an hour.
For medical centers: The American Heart Association/ American Stroke Association’s national quality initiative Target: Stroke℠ aims to reduce the time between stroke symptoms and treatment. Since its initiation in 2010, the percentage of patients treated within 60 minutes or less from hospital arrival has increased from less than one-third to more than one-half. Additionally, the average time from arrival to treatment dropped from 74 to 59 minutes. These faster treatment times have reduced the percentage of stroke patients who died in the hospital from 9.9% to 8.3%. The improvements were seen in patients regardless of age, sex, or race.
Ideally, the implementation of these solutions – and many more that are in the works – will continue to reduce the risk of, and from, stroke.
To view the Outline, Cause Map and solutions related to inadequate treatment for stroke patients, please click “Download PDF” above. Or click here to read more.