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New recommendations for stroke systems of care to improve patient outcomes

Improvements in stroke systems of care are necessary to ensure  scientific advances in the treatment and care of stroke patients improve  patient outcomes, according to a policy statement published today by  the American Stroke Association, a division of the American Heart  Association, in the journal Stroke.                                                 

The ,  released during National Emergency Medical Services (EMS) Week, comes  as stroke systems of care have seen vast improvements in availability of  endovascular therapy, neurocritical care and stroke center  certification over the past decade. In addition, innovations such as  telestroke and mobile stroke units have increased access for stroke to alteplase, a lifesaving, clot-busting drug.
"We have seen monumental advancements in acute stroke care over the  past 14 years, and our concept of a comprehensive stroke system of care  has evolved as a result," said Opeolu Adeoye, M.D., the chair of the  writing group for the statement and associate professor of emergency  medicine and neurosurgery at the University of Cincinnati. "These  recommendations reflect how far we have progressed and what still needs  to be accomplished to maximize in acute stroke care."
The statement recommends that when more than one intravenous alteplase-capable is within reach, Emergency Medical Services (EMS) should consider  additional travel time of up to 15 minutes to reach a hospital capable  of performing endovascular thrombectomy (also called stent retrievers)  for patients suspected of having a severe stroke. Both intravenous  alteplase, a clot-dissolving therapy, and endovascular thrombectomy, a  procedure to remove a clot mechanically, must be administered quickly to  be effective, but not every hospital is able to deliver these services.
"While it is vitally important for patients suspected of having a  large vessel blockage to get to the hospital quickly, getting to the  right hospital is equally important," Adeoye said.
The statement also addresses disparities in care among racial and  ethnic minorities, who are less likely to use EMS and have the lowest  awareness of the causes and symptoms of stroke. Among Hispanic and black  populations in particular, lack of knowledge of the risk factors and  symptoms of stroke can hamper timely stroke care.

In response, the statement recommends that public health leaders and  medical professionals implement public education programs focused on  stroke systems and the need to seek emergency care by calling 9-1-1 in  response to stroke symptoms.
The statement also includes the following recommendations:
Education: Stroke systems of care should support local and regional  public education initiatives to increase awareness of stroke symptoms  with an emphasis on at-risk populations.
Triage: EMS leaders, governmental agencies, medical authorities and  local experts should work together to adopt consistent, standardized  triage protocols to rapidly identify patients with a known or suspected  stroke.
Secondary Prevention: Certified stroke centers should help stroke  survivors reduce the of risk of subsequent strokes, consistent with the  national guidelines for secondary prevention.
Rehabilitation and Support: A stroke system should provide  comprehensive post-stroke care including ongoing primary care and  specialized stroke services such as physical, occupational, speech or  other therapies on discharge.
Federal and State Policies: Policies should be enacted to standardize  the organization of stroke care, lower barriers to seeking emergency  care for stroke, ensure receive care at appropriate hospitals in a timely manner, and  facilitate access to secondary prevention and rehabilitation and  recovery resources after stroke.
A stroke occurs every 40 seconds in the U.S., and someone dies of a  stroke every four minutes. An estimated 7.2 million Americans aged 20  years or older have had a stroke, and approximately 800,000 people in  the U.S. have a new or recurrent stroke each year.
Optimized systems of care that span from primordial prevention to rehabilitation and recovery help to  ensure patients, caregivers and providers have the tools needed for  prevention, treatment and recovery.
Implementation of the American Heart Association's Get With The  Guidelines—Stroke at U.S. hospitals has been associated with an 8  percent reduction in mortality at one year and improved functional  outcome at hospital discharge.