Stroke patients got the critical medication they needed faster at hospitals where basic communications were improved and other research-based tactics were used, according to new research evaluating treatment at hundreds of hospitals.
Speed of treatment has been proven to be vital after stroke, saving lives and helping survivors avoid long-term disabilities. Stroke is the No. 4 cause of death in the U.S., and a leading cause of serious disability.
In the study published Tuesday in the American Heart Association journal Stroke, researchers surveyed 304 hospitals enrolled in the association’s Get With The Guidelines-Stroke program to determine if they were implementing 11 strategies for improving early treatment after ischemic stroke – caused by blocked blood vessels in or near the brain. The hospitals had enrolled in but had not yet started implementing Target: Stroke, an American Heart Association/American Stroke Association program created to speed stroke treatment nationwide.
The only approved treatment for ischemic stroke is an intravenous drug called tissue plasminogen activator, or tPA, which helps dissolve blood clots. The American Heart Association/American Stroke Association recommends stroke patients receive tPA within 60 minutes of hospital arrival, but research shows only a third of eligible U.S. patients are treated within this timeframe.
The median time to treatment for hospitals surveyed was 72 minutes. However, hospitals using the 11 strategies reduced treatment time by 1.3 minutes per strategy, researchers said. Implementing all 11 strategies gives hospitals the potential to save 14 minutes, which could spare thousands of stroke patients a lifetime of disability.
“For every minute that treatment is delayed in a typical large vessel ischemic stroke, nearly 2 million neurons die,” said Gregg C. Fonarow, M.D., a researcher in the study who is also an American Heart Association volunteer. “Therefore, rapid treatment is a critical factor in the outcomes of patients with acute stroke who are treated with intravenous tPA.”
The three most effective strategies for lowering treatment times in the study could be considered fairly simple, involving better communications and availability of tPA. They were:
- Being alerted by emergency medical services that a stroke victim was en route, saving an average of 8.1 minutes in time to treatment.
- Having a single phone call activate hospital stroke teams, saving 4.3 minutes.
- Storing tPA in the emergency department, saving 3.5 minutes.
All of the hospitals surveyed used some of the strategies but often not the most effective ones, Fonarow said.
“This may account, in part, for the substantial delays to acute stroke treatment in the United States,” said Fonarow, who is the Eliot Corday Professor of Cardiovascular Medicine and Science and director of the Ahmanson-UCLA Cardiomyopathy Center at the David Geffen School of Medicine at the University of California, Los Angeles.
Early results from the research were published in 2013, but Tuesday’s report includes more complete data about how the hospitals used the strategies.
Here is a brief look at all 11 strategies the hospitals in the survey were asked about:
- Being alerted by emergency medical services that a stroke victim was en route
- Having a single phone call activate hospital stroke teams
- Storing tPA in the emergency department
- Procedures to quickly triage stroke patients and notify the stroke team
- Accessing stroke experts 24 hours a day/7 days a week
- Fast brain imaging and interpretation
- Rapid laboratory testing
- Having procedures in place for giving tPA
- Mixing tPA ahead of time
- Using a team-based approach
- Getting prompt data feedback
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