Newswise — Research by a Michigan State University epidemiologist finds that few acute-stroke patients are receiving care that is consistent with established guidelines.
The work of Mathew Reeves, an assistant professor in MSU's Department of Epidemiology, reveals that fewer than a quarter of patients arrive at an emergency room within three hours of the onset of symptoms, and that fewer than 5 percent of stroke patients eligible for clot-busting medication receive it.
Reeves' research is documented in the journal Stroke: Journal of the American Heart Association.
"We're losing between 50 and 70 percent of patients right from the get-go because we don't know exactly when the stroke occurred," Reeves said. "If we don't know when a stroke occurred, then we are unable to give the patient the acute stroke therapies that are available."
Having patients arrive within three hours of having a stroke is critical, Reeves said, because this is the window of opportunity for treatment with tissue plasminogen activator (tPA), the only U.S. Food and Drug Administration-approved treatment for acute ischemic stroke. Ischemic stroke is caused by a clot in the arteries supplying blood to the brain.
"Overall, 75 to 80 percent of patients don't arrive within the three-hour window for treatment," Reeves said. "The data reaffirm that we need to do a lot more in terms of public education to improve recognition and response to the warning signs of stroke."
Reeves and his team gathered the data from the Paul Coverdell National Acute Stroke Registry. The registry gathered information on more than 6,000 stroke admissions at 98 hospitals between October 2001 and November 2002. It was determined that between 50 percent and 70 percent of the patients had suffered an ischemic stroke.
Four states participated in the registry " Michigan, Ohio, Georgia and Massachusetts. The registry is named in honor of Paul Coverdell, a U.S. senator from Georgia who died of a stroke in 2000.
According to the data, of the 4,280 patients who had ischemic stroke, only 177, around 4 percent, received tPA. Across the four states, treatment rates ranged from 3 percent in Georgia to 8.5 percent in Massachusetts.
The analysis also revealed that many stroke patients did not receive recommended preventive care before leaving the hospital. Examples included cholesterol measurement, an evaluation for dysphagia or difficulty swallowing, and smoking-cessation counseling.
"For a stroke survivor who smokes, smoking cessation is the single best thing that can be done to reduce the risk of subsequent stroke," Reeves said.
Hospitals did better with respect to sending patients home on aspirin or other medications to prevent clot formation. Rates of antithrombotic therapy ranged between 87.7 percent and 97.7 percent. Of the patients with atrial fibrillation, a type of rapid heartbeat that increases the risk of stroke, between 64.1 percent and 91 percent received blood-thinning drugs to prevent clots.
Reeves' work was part of the Michigan Acute Stroke Care Overview and Treatment Surveillance System, or MASCOTS, a collaboration between MSU and 15 Michigan hospitals that is reviewing how stroke victims are cared for in Michigan.
For additional information on the project, visit the Web at http://www.epi.msu.edu/mascots/
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