The improved access to treatment did not cost more; neither were the in-hospital costs any higher for patients treated by stroke teams, say researchers.
The thrombolytic (clot-busting) drug tissue plasminogen activator (tPA) is the only early treatment for acute ischemic stroke approved by the Food and Drug Administration. It must be given within three hours of the onset of stroke symptoms. It helps restore blood flow to areas of the brain and surrounding blood vessels affected by an ischemic stroke. Ischemic strokes are caused by blockages in an artery to the brain.
“We know thrombolytics are effective – and this study suggests that thrombolytics have the potential to be used more often with a stroke team in place,” says Brett C. Meyer, M.D., the study’s lead author and an assistant professor of neurosciences at the University of California San Diego Medical Center.
Investigators compared tPA use during a two-year period at the San Diego Medical Center and neighboring hospitals. In the first year, from July 1999 through June 2000, a stroke team was not available for emergency stroke care. Patients were evaluated by the general neurology team. In the second year, from July 2000 through June 2001, a dedicated stroke team was in place. The stroke team consisted of neurologists and physicians specially trained in stroke treatment and faculty on 24-hour call for evaluation and treatment of stroke patients.
Thrombolytics were administered 12 times (about once each month) in the year without a stroke team; tPA use increased to 25 times (about 2.1 times each month) in the year with the specialized team.
Having a dedicated stroke team available also made it possible to help neighboring hospitals evaluate acute ischemic stroke patients and, when appropriate, treat them with thrombolytics. An additional 11 patients were treated with tPA at neighboring hospitals where members of the stroke team also had hospital staff privileges, says Meyer.
The study challenged a concern that dedicated stroke teams could raise the costs of care for treating stroke patients. The study revealed no significant change in direct hospital costs with the use of dedicated stroke teams. The costs were $4,232 per patient during the year without a stroke team, versus $4,447 per patient for those evaluated by a stroke team. Costs included direct costs/charges associated with admission. Length of stay was equivalent in both groups: 4 days in the year without the specialized stroke team and 4.1 days for the year with the stroke team.
“This study suggests that stroke teams represent a wise allocation of resources,” says Meyer. Although this particular study did not examine stroke outcomes, numerous studies have shown that using tPA in the recommended three-hour window reduces stroke-related disability.
American Stroke Association guidelines call for administering tPA within three hours of an acute ischemic stroke in appropriate patients, because early treatment offers the best chance of limiting brain injury and preventing stroke-related disability. The association offers a tool kit called Acute Stroke Treatment Program, which gives hospitals information on establishing primary stroke centers. A key element of a primary stroke center is an acute stroke team.
“Only about 5 percent of stroke patients in the United States currently receive tPA,” says Edgar J. Kenton, M.D. chairman of the American Stroke Association Advisory Committee and Chief of Cerebrovascular Disease at Mainline/Jefferson Health System in Wynnewood, Pa. “Dedicated stroke teams are increasingly viewed as a crucial link in the chain of survival for acute stroke victims, because their ability to respond rapidly with assessment and treatment has the potential to minimize disability.
“We hope that this study will assist the association through its Operation Stroke program and Acute Stroke Treatment Program tool kit to raise the quality of stroke care in all hospitals.”
Co-authors of the study are Thomas M. Hemmen, M.D.; Kristine A. Hayes, M.D.; Teri L. McLean, M.D.; and Patrick Lyden, M.D.
Editor’s note: For more information on the American Stroke Associations’ Acute Stroke Treatment Program and Operation Stroke, visit this website: americanstroke.org.