• Stroke care networks save lives, improve outcomes, study shows

    July 2013  

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    A comprehensive regional stroke care network saves lives and reduces the need for long-term after-stroke care. Those are the findings of a study published in the May 2013 Canada Medical Association Journal (CMAJ) that looked at the impact of the Ontario (Canada) Stroke System, one of the largest and longest-operating stroke networks in Canada. Regional stroke networks integrate and coordinate stroke treatment so that patients get timely, advanced stroke care, even if they don’t live near a designated stroke center.


    “After the stroke network was introduced, there were clear improvements in the quality of stroke care. More patients were treated with optimal stroke care interventions, such as thrombolysis, including clot-busting drugs and stroke-unit care.” 


    These findings have implications in the United States as well. According to the American Heart Association/American Stroke Association, stroke is one of the leading causes of death and serious, long-term disability in the United States. On average, someone suffers a stroke every 40 seconds; someone dies of a stroke every four minutes; and 795,000 people suffer a new or recurrent stroke each year.

    Stroke was the third leading cause of death in Kentucky as of 2010, the most recent data available.

    There are two types of stroke, according to the Centers for Disease Control and Prevention. An ischemic stroke occurs when blood flow to the brain is blocked by blood clots or fatty deposits or plaque in the lining of the blood vessels. Most strokes are ischemic. The other type of stroke is hemorrhagic, caused when a blood vessel bursts in the brain.

    Study findings

    The study reported the following significant impacts of the Ontario Stroke System after its implementation in 2005:
    • An increase in the proportion of patients receiving care at either a regional or district stroke center, from 40 percent up to 46.5 percent.
    • A decrease in the rate of patients discharged to long-term care facilities, from 16.9 percent down to 14.8 percent.
    • A decrease in the 30-day mortality for patients with hemorrhagic stroke, from 38.3 percent down to 34.4 percent.
    • A decrease in the 30-day mortality for patients with ischemic stroke, from 16.3 percent down to 15.7 percent.
    • An increase in the proportion of patients receiving thrombolytic therapy (10 percent up to 27 percent), antithrombotic therapy (80 percent up to 94 percent), carotid imaging (44 percent up to 68 percent), neuroimaging (77 percent up to 93 percent), and care in a stroke unit (3 percent up to 24 percent). The study authors noted that regional and district stroke centers saw the biggest improvements, with little change found at nondesignated centers. They also noted that the increase in patients seen at the stroke centers was modest, even five years after the implementation of the network. They theorized this may be because the system was designed to transfer to stroke centers only those patients who were good candidates for thrombolytic therapy or neurosurgical interventions.

    The decreases in 30-day mortality were estimated to result in 200 fewer stroke-related deaths as well as 300 fewer patients annually requiring long-term or chronic care.

    About the study

    Using piecewise regression analyses, the 10-year study looked at data on 243,287 emergency department patient visits and 163,198 hospital admissions for acute stroke or transient ischemic attack before and after the stroke network became fully operational in 2005.

    Researcher Moira Kapral, MD, of the University of Toronto Institute for Clinical Evaluative Sciences told MedPage Today that, “After the stroke network was introduced, there were clear improvements in the quality of stroke care. More patients were treated with optimal stroke care interventions, such as thrombolysis, including clot-busting drugs and stroke-unit care.”

    Limitations

    The study’s authors noted that their research focused on hospital-based processes of care and outcomes; they did not have information on longer-term outcomes including a patient’s functional status or quality of life. Their analysis also did not take into account the possible effects of other treatments. They suggested “future research should focus on identifying the specific components of such systems that are most likely to account for improvements in outcomes.”


    F.A.S.T.

    F.A.S.T. is an easy way to remember the sudden signs of stroke:

    F – Face drooping. Ask the person to smile. Is it uneven, or is one side of the face numb?

    A – Arm weakness. Ask the person to raise both arms. Does one arm drift downward or is one arm weak or numb?

    S – Speech difficulty. Ask the person to repeat a simple sentence, like, “The sky is blue.” Is the sentence repeated correctly, is speech slurred or is the person unable to speak or hard to understand?

    T – Time to call 911. If someone shows any of these symptoms, even if the symptoms go away, call 911 and get to the hospital immediately. Note the time when symptoms first appeared. – American Stroke Association

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Page last updated: 5/20/2014 11:15:26 AM
  • What the news means for you

    Access to timely care is key to stroke survival

    Michael R. Dobbs, MD
    Neurologist

    Wright, Heather, MDThis study validates what we’ve believed for a long time – an organized, comprehensive regional stroke network can save people’s lives and improve quality of life after a stroke by making sure patients have timely access to advanced care.

    UK had the first stroke center in the region to be designated as a Primary Stroke Center by The Joint Commission. With a stroke, time lost is brain lost, and the UK HealthCare Stroke Program is committed to being one of the top hospitals in the country for providing aggressive, proven stroke care.


    “...The UK HealthCare Stroke Program is committed to being one of the top hospitals in the country for providing aggressive, proven stroke care.” 


    Importance of clot-busting drug tPA

    Recent data shows that at least 15 percent of UK’s eligible ischemic stroke (the most common type of stroke) patients have received tissue plasminogen activator, or tPA, within 60 minutes of arriving at the hospital (known as “door-to-needle” time). A thrombolytic, or clot-busting agent, tPA is the only drug approved by the U.S. Food and Drug Administration for the urgent treatment of ischemic stroke. If given intravenously in the first three hours after the start of stroke symptoms, tPA has been shown to significantly reverse the effects of stroke and reduce permanent disability.

    Community-based approach

    In December 2008, UK HealthCare started a stroke care affiliate network with one rural hospital. The network is now a 25-hospital alliance in Kentucky and West Virginia.

    The UK Comprehensive Stroke Center and Norton Healthcare in Louisville are working together with area hospitals to develop the first community-based stroke program in the region, providing the highest quality clinical care and educational programs to hospital staff and community members. Each affiliate hospital is committed to providing the most current and effective stroke care for its community. This means that patients get the best care possible during the early moments of a stroke, when diagnosis and administering rapid treatment are extremely important. UK and Norton support these efforts with clinical guidance and oversight, making sure stroke patients receive the right treatment at the right time.

    For many years, our volume of stroke patients treated at UK increased, but over the past two years, our volumes have leveled off. However, the severity of the stroke patients we see has increased. This says to me we have accomplished our goal of having milder stroke patients get needed treatments closer to home, with those patients needing more specialized care coming to UK.

    Stroke rates expected to rise

    It is critical that our stroke network continue to focus on improving stroke care for our patient population. The number of acute ischemic stroke patients in our region who would be eligible for treatment is expected to grow over the next decade due to higher rates of high blood pressure, smoking and diabetes compared to other areas of the country, according to the Centers for Disease Control and Prevention. That’s why the stroke network is not just vested in improving patient care; we also want to educate people about how they can minimize their risk of stroke through lifestyle changes that include managing blood pressure and cholesterol levels and stopping tobacco use.

    We have screened more than 10,000 people for stroke risk and educated thousands of children in how to prevent vascular disease. I believe we are the only stroke network in the United States that is doing this much outreach for primary stroke prevention.

    For more information about the stroke affiliate network, call 800-333-8874 or visit ukhealthcare.uky.edu/stroke and click on“Stroke Affiliate Network.” 

    Dr. Dobbs directs the UK HealthCare and Norton Healthcare Stroke Network and is an associate professor and interim chair and service chief of neurology at the UK College of Medicine.

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