Policy statement outlines components of successful stroke care



Government agencies, health care authorities, and medical leaders should support the formation and certification of stroke centers and the use of telemedicine systems to improve care, according to a policy statement issued by the American Heart Association and the American Stroke Association.

Other recommendations in the statement – which describes the components needed for a modern system of stroke care in the United States – involve establishing a system that provides universal access to poststroke care and developing hospital protocols that reflect current stroke care guidelines.

Dr. Randall Higashida

These are among the 10 policy recommendations that describe concepts and elements to be included in "stroke systems of care that are intended to optimize patient care and management processes and improve patient outcomes, are practical to implement, and are supported by existing clinical data or expert consensus opinion," the statement said.

The paper, "Interactions Within Stroke Systems of Care," was published Aug. 29 in Stroke (doi:10.1161/STR.0b013e3182a6d2b2).

The lead authors are Dr. Randall Higashida, chair of the American Heart Association Advocacy Coordinating Committee, and Dr. Mark Alberts, cochair.

A "fully functional" system of stroke care would reduce the number of deaths by 20,000 in the United States and by about 400,000 worldwide. In addition, such a system would reduce disability after strokes, which would improve quality of life and would lower costs for patients, their families, third-party payers, and governments, according to the statement.

Dr. Mark J. Alberts

Recommendations for the main elements of a stroke system of care range from calling 911 to the interactions of different types of health care professionals involved in the care of patients in a stroke center to discharge and rehabilitation.

The first recommendation advises medical professionals and public health leaders to "design and implement" public education programs about stroke symptoms and the need to seek emergency care quickly.

Since designated stroke centers have been shown to improve patient care and outcomes, including lower death rates, another recommendation is for health care professionals, medical leaders, and government agencies to support the formation, operation, and certification of such centers. The statement includes descriptions of different acute inpatient stroke care facilities, including a comprehensive stroke center, primary stroke center and acute stroke–ready hospital.

In addition, hospitals caring for stroke patients "within a stroke system of care should develop, adopt and adhere to care protocols that reflect current care guidelines" that have been established by national and international professional organizations, and state and federal agencies.

Governments, payers, vendors, and health care institutions should support the use of telemedicine resources and "telestroke" systems to ensure that stroke patients in a variety of settings have adequate around-the-clock care, according to another recommendation that noted the "limited distribution and availability of neurological, neurosurgical, and radiological expertise."

Other recommendations pertain to transfer protocol and criteria, reimbursement issues, legal issues in stroke care, and rehabilitation.

The authors state that local and regional health care providers and government officials and related agencies should adopt the procedures and policies described in the statement. The statement concludes that "any system of care will only be as strong and efficient as its weakest link," and that by following the principles in the statement, "we hope to minimize or eliminate any weak links."

Dr. Higashida, chief of the division of interventional neurovascular radiology at the University of California San Francisco Medical Center, had no disclosures. Dr. Alberts, professor of neurology and neurotherapeutics at the University of Texas Southwestern Medical Center, Dallas, disclosed having received honoraria or serving on the speakers bureau for Genentech. Of the 15 remaining members of the committee, 6 had no disclosures. The remaining committee members’ disclosures included serving as a consultant or adviser to Genentech, W.L. Gore, Covidien, and/or the National Stroke Association, and receiving grants from the National Institutes of Health and/or the National Institute of Neurological Disorders and Stroke, the National Stroke Association, and Genentech.

Recommended Reading

Fungal meningitis can masquerade as ischemic stroke
MDedge Cardiology
Decompression for malignant stroke in elderly lowers death, disability
MDedge Cardiology
Stroke outcomes poorer when criteria precluded endovascular therapy
MDedge Cardiology
Exercise frequency matters for reducing stroke risk, at least for men
MDedge Cardiology
New risk scheme to predict stroke in AF
MDedge Cardiology
Early surgery for intracerebral bleeds may benefit a select few
MDedge Cardiology
Hypertensive retinopathy predicts stroke risk
MDedge Cardiology
Percent insula infarction may help predict stroke treatment response
MDedge Cardiology
Early thrombolysis benefits moderate and mild stroke patients
MDedge Cardiology
Acute onset arthritis possible with clopidogrel
MDedge Cardiology