Stroke care: Where you live makes a huge difference

Ischemic strokes, in which a vessel supplying blood to the brain is blocked, are the most common type of stroke, representing 87 percentof all strokes.

Treatment within the first minutes or hours of the start of a stroke can mean the difference between resuming life and permanent disability. However, emergency stroke treatment varies greatly by where a patients lives, according to researchers from the University of Michigan Medical School.

Researchers examined the use of “clotbuster” drugs in more than 3,400 U.S. hospitals. Only 4.2 percent of more than 844,000 stroke victims received the drug called tissue plasminogen activator (tPA), or another urgent stroke treatment, the study finds.

The study was published in the July issue of the journal Stroke.

The finding is concerning because tPA is an effective treatment for ischemic strokes, but it works when given within 3 hours (4.5 hours for a subset of patients) of the onset of stroke symptoms.

Ischemic strokes, in which a vessel supplying blood to the brain is blocked, are the most common type of stroke, representing 87 percentof all strokes.

“Regional differences are a big part of variability in tPA use” says James Burke, M.D., M.S., the study’s senior author and an assistant professor in neurology at U-M and the VA Ann Arbor Healthcare System.

Dr. Burke says that the reasons for the regional differences are difficult to pinpoint and that there is a “chain” of response– from patients or families calling ambulances, transport by emergency medical system (EMS), and medical evaluation at the hospital.

“The take home, trying to explain which parts of the chain are most important and learn how to get the country to the level of high performing hospitals,” says Dr. Burke.

The highest performing regions, such as Stanford, CA and Asheville, NC, give tPA or other advanced treatments to as many as 14 percent of stroke patients.

The researchers calculated that if all regions achieved the same rates of tPA use as the Stanford region, more than 92,800 people would get treated, and 8,078 people would survive their stroke disability-free.  Even if all regions doubled their current tPA use, 7,206 people would be spared disability.

Thousands of people a year may end up unnecessarily disabled as a result of not receiving ideal care.

Analyses of the top performing areas did not yield easy answers to explain the regional tPA use differences. The top 20 areas for tPA use are scattered across the country, in urban and rural areas, rich and poor ones.

Variation in tPA use did track to lower average levels of education and income, and higher unemployment, in hospital service areas, and use was slightly higher across all densely populated areas compared with more sparsely populated areas.

Women, people who are an older age and African-Americans were less likely to be offered tPA.

Dr. Burke says the next step is digging in and understanding those differences. Then, use what they learn to improve emergency stroke care across the nation.

 

 

 

 

 

 

 

 

 

Caroline Leopold

Caroline Leopold writes on behavioral medicine and infectious disease surveillance. In addition, Ms. Leopold consults with universities and startups to help investigators apply for NIH R01 and SBIR grants.

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