FOR RELEASE: 4 p.m. ET, ThursdayMarch 1, 2001
CONTACT: For journal copies only,please call: (214) 706-1396For other information, call:Bridgette McNeill: (214) 706-1135Carole Bullock: (214) 706-1279 [email protected]
American Heart Association journal report:Collaboration speeds stroke treatment for rural Canadians
DALLAS, March 2, 2001 -- Thanks to a new collaborative approach to treating strokes in a rural part of Canada, bypassing the nearest hospital didn't mean passing up time-sensitive, brain-saving treatment, according to a study in the March issue of Stroke: Journal of the American Heart Association.
A group of Canadian medical professionals developed a system to try to ensure that individuals in a largely rural area could get to a hospital within the critical three-hour time window for using the clot-busting drug tPA to treat ischemic strokes. The system, Regional Acute Stroke Protocol (RASP), called for sometimes bypassing the nearest hospital in favor of a specialized stroke treatment facility at Kingston General Hospital, which is associated with the Southeastern Ontario Academic Health Sciences Center in Kingston.
Kingston General Hospital has a stroke collaborative care program involving a multidisciplinary stroke team. Throughout the region, more than 500 emergency dispatchers, paramedics, nurses and allied health professionals were trained on the RASP guidelines. RASP protocol included rapid assessment by paramedics, including a precise determination of the time of symptom onset, bypassing the closest hospital and contacting the stroke treatment facility while enroute about 30 minutes away. Community hospitals who received "walk-in" acute stroke patients meeting the time criteria were instructed to begin blood tests, rapidly transfer patients to the stroke facility and transmit test results there. At Kingston General Hospital, a stroke team is in place when the patient arrives and patients are "next on scan" -- meaning they are top priority for the next available CT scan, a critical diagnostic test to determine eligibility for tPA treatment.
RASP reduced geographical barriers and increased access to timely acute stroke treatment for individuals in rural areas. After a year of operation, about 403 ischemic strokes (caused by blood clots) occurred in the area; RASP was activated 191 times and 42 individuals (22 percent) received tPA - slightly more than 10 percent of the acute ischemic stroke population.
"The key finding of this study is that citizens living in a large rural geographical area can have equitable access to time-dependent interventions if there is a coordinated system response to stroke as an emergency," says lead author Richard J. Riopelle, M.D., formerly of Queens University in Kingston, Ontario, Canada and now chair of neurology and neurosurgery at McGill University in Montreal.
"Kingston General Hospital is the only major medical facility in the region and the only hospital offering the clot-busting treatment," explains Riopelle. "Transporting stroke patients to the nearest hospital would mean that about 75 percent of the region's population would be ineligible for tPA. In order to offer this therapy to the entire region we felt we had to make changes in the way patients move through the system."
Southeastern Ontario is a 12,400 square-mile mixed urban-rural region of about 500,000.
In the 191 RASP activations, 40 percent had bypassed the closest hospital and 20 percent were transported from a community hospital. These groups comprised about 50 percent of the tPA-treated group. Individuals having a stroke arrived within the three-hour window from locations as far as 112 miles away. Among the activations, 62 percent were men and the average age was 69. Forty-five percent of the them had hypertension and 38 percent had suffered previous transient ischemic attacks (TIA) -- "mini-strokes." Atrial fibrillation and high cholesterol were present in 10 percent of patients.
In the United States, the American Stroke Association, a division of the American Heart Association, has developed two programs to help ensure timely delivery of tPA.
Operation Stroke is a grassroots initiative to raise awareness of stroke warning signs and the critical need for immediate emergency treatment. The association is leading a massive awareness campaign with the implementation of Operation Stroke in 77 U.S. cities, and is expanding to more than 125 cities by 2003. In addition to public education, the program is designed to educate dispatchers, emergency transport drivers, paramedics, fire and police officers, and medical professionals about the importance of rapid treatment. It also is working to increase the number of hospitals equipped and staffed to deal with the specific needs of stroke patients.
In an effort to strengthen the chain of survival for stroke patients, the association recently created the Acute Stroke Treatment Program based on recommendations from the Brain Attack Coalition -- a multidisciplinary group of representatives from major professional organizations including the American Stroke Association involved with delivering stroke care. This program guides hospitals through a step-by-step process for establishing primary stroke center operations.
"The short time window for administering tPA presents special problems for patients that live in rural areas," says Harold P. Adams, Jr., M.D., an American Stroke Association spokesman. "Thus, the experience of Riopelle et al is very important. They were able to treat approximately 10 percent of patients with tPA, a truly laudable result. This method used in Kingston might not work in all places, but its results serve as an impetus to try similar strategies in the United States."
Other researchers of the Canadian study include D.C. Howse, M.D.; C. Bolton, MBA; S. Elson, MA; D.L. Groll, MSc; D. Holtom, ACNP, D.G. Brunet, MD; A.C. Jackson, M.D.; M. Melanson, M.D.; and D.F. Weaver, M.D.
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NR01-1262 (Stroke/Riopelle)Media Advisory: Dr. Riopelle can be reached at (514) 398-1902, by fax (514) 398-7371 and by e-mail [email protected] or [email protected]. (Please do not publish contact information.)
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