Keeping Up with Stroke Advances
Despite strides in neuroscience and stroke care, leading organizations are finding there are still improvements that can be made.
This article first appeared in the April 2015 issue of HealthLeaders magazine.
Peter Rasmussen, MD
Hospitals and health systems have increased their focus on stroke care over the years, which in turn has helped contribute to reducing stroke deaths as well as improving outcomes for stroke patients; however, there are still significant gains that some hospital-based neuroscience leaders say can be made.
"We feel attention to stroke care is underrated," says Peter Rasmussen, MD, director of Cleveland Clinic's Cerebrovascular Center. "Proper stroke care is not universally available. Generally in the United States, it is not what it should be or could be."
In January, the American Heart Association released its annual update on heart disease and stroke data showing that, from 2000 to 2010, the annual stroke death rate decreased 35.8% and the actual number of stroke deaths declined 22.8%. That's a noteworthy drop, but, on average, someone dies from a stroke every four minutes. Getting to the patient quickly to diagnose what type of stroke is occurring is key, and the phrase many in neurology use is, "Time is brain."
Indeed. Strokes injure the brain, and the severity of the damage depends almost completely on time. Ischemic strokes, caused by a clot that blocks blood from getting to the brain, occur the most. In fact 87% of strokes are ischemic; 10% are classified as intracerebral hemorrhage (bleeding within the brain), and 3% are subarachnoid hemorrhagic (bleeding just outside the brain). When treated quickly, it means better outcomes for patients. For hospitals, it means shorter lengths of stay, and lower rehab costs.
The gold standard of clot-busting drugs, tissue plasminogen activator (tPA), is the key factor in timely treatment of stroke. The FDA-approved drug dissolves clots blocking blood to the brain, reducing what doctors call "door-to-needle time," which is the primary measure hospital leaders use to determine stroke care progress. Despite its effectiveness, tPA is used in less than 10% of ischemic stroke cases, and when it is used, most hospitals administer it outside the recommended 60-minute window. The drug is effective up to 4.5 hours after stroke onset, but the sooner it is given, the better the outcome.
To help improve their stroke measures, many hospitals have become certified by The Joint Commission as either primary or comprehensive stroke centers. The Joint Commission began its primary certification program in 2003. Hospitals must meet eight core measures every two years to receive primary certification. Hospitals took the stroke program seriously and, by 2007, the AHA and American Stroke Association recommended taking stroke patients to the nearest stroke center instead of just the nearest hospital.