Four out of five people in the United States live within an hour's drive of a hospital equipped to treat acute stroke -- yet very few get recommended treatment, according to research presented at the American Stroke Association's International Stroke Conference 2014.
Of the more than 370,000 Medicare stroke claims for 2011 that researchers examined:
- Only 4 percent received tPA, a drug that can reduce disability if given intravenously within three to four hours after the first stroke symptoms.
- Only 0.5 percent had endovascular therapy to reopen clogged arteries.
These treatments are most likely available at designated stroke centers, where a team of providers are trained to quickly diagnose and treat strokes.
"If a patient suspects they are having a stroke, they need to call 9-1-1 immediately and get to the nearest stroke center as soon as possible, which might mean bypassing another hospital that isn't set up to deliver the necessary therapy," said Opeolu Adeoye, M.D., M.S., the study's lead author and associate professor of emergency medicine and neurosurgery at the University of Cincinnati.
"We strongly suggest that patients go to the hospital by ambulance, that they or whoever is with them ask to go to a stroke center and ask for tPA." The study found that within an hour's driving time:
- Eighty-one percent had access to a hospital capable of administering tPA.
- Sixty-six percent had access to a primary stroke center.
- Fifty-six percent had access to a hospital capable of performing endovascular therapy.
Within an hour by air:
- Ninety-seven percent could reach a tPA-capable hospital.
- Ninety-one percent could reach a stroke center.
- Eighty-five percent could reach a hospital capable of performing endovascular therapy.
In 2011, 60 percent of U.S. hospitals didn't administer tPA. These hospitals discharged about 1 in 5 of all stroke patients.
"Every 15-minute delay in getting treatment increases the odds of that patient not being able to go home," Adeoye said. "Calling 9-1-1 is best if a stroke is suspected because paramedics should know which hospitals are stroke centers and can alert the stroke team in advance of the patient's arrival, all of which saves time."
Co-authors are: B.G. Carr, M.D., M.S.; K.C. Albright, D.O.; C. Wolff, B.S.; M. Mullen, M.D., M.S.; T. Abruzzo, M.D.; A. Ringer, M.D.; P. Khatri, M.D., M.S.; C. Branas, Ph.D.; and D. Kleindorfer, M.D. Author disclosures are on the abstract.
The Center for Disease Control and Prevention and the Agency for Healthcare Research and Quality funded the study. Hospitals certified as a Primary Stroke Center or Comprehensive Stroke Center can be found on the American Heart Association/American Stroke Association's Quality Map.
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For additional information on stroke warning signs, visit: http://powertoendstroke.
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Note: Actual presentation is 7 a.m. PT on Thursday, Feb. 13, 2014.