Published: Jan. 25, 2011
Updated: Jan. 25, 2011
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By Duke Medicine News and Communications
Patients with acute ischemic strokes treated at designated stroke centers are significantly more likely to survive and get clot-busting medication than those treated at non-certified hospitals, according to a study published in the Journal of the American Medical Association by researchers at the Duke Clinical Research Institute.
In this large observational study involving more than 30,000 patients, researchers found that a state-certified stroke center was associated with fewer deaths and more frequent use of thrombolytic therapy, a medication that, if given in time, breaks down blood clots that cause the stroke and minimize the damage to the brain.
"The idea of designated stroke centers was born after research concluded that many lives could be saved if our medical system had the necessary personnel, equipment and organization to treat stroke patients rapidly and efficiently," said Ying Xian, MD, a fellow with the Duke Clinical Research Institute and lead author of the study.
Designated stroke centers are designed to provide care by a team of professionals who specialize in stroke management who work together to provide timely care to stroke patients. The centers are typically comprised of a dedicated acute stroke team and include coordination with emergency medical services, hospital emergency departments, neurosurgery, imaging and laboratory services.
In 2000, Brain Attack Coalition, a group of physician organizations and governmental entities, put forward recommendations outlining the stroke center concept in response to the need to improve acute stroke care. Three years later the Joint Commission began certifying centers based on the recommended criteria.
Approximately 700 hospitals are certified nationwide and some states have established their own designation programs, adding an additional 200 designated stroke centers in the U.S.
In the new study, data from the New York Statewide Planning and Research Cooperative System was used to compare death rates for patients admitted with acute ischemic stroke at designated stroke centers and non-designated hospitals. The data was pulled from 2005 and 2006 and patients were followed for one year after hospitalization.
Xian said half of the patients with acute ischemic stroke were treated at designated stroke centers and the other half non-designated hospitals. After 30 days, the all-cause mortality rate was 10.1 percent for patients admitted to designated stroke centers and 12.5 percent for patients admitted to non-designated hospitals. Differences in death rates also were observed one day, one week and one year after being hospitalized.
Use of thrombolytic therapy was nearly 5 percent for patients admitted at designated stroke centers and less than two percent for patients admitted at non-designated hospitals. The data were also compared to mortality for patients admitted with gastrointestinal bleeding or heart attack, confirming the differences were specific for stroke.
"The basic premise of stroke centers and stroke care -- that coordinated care delivered around a specific disease can likely improve outcomes -- is widely accepted," said Robert Holloway, MD, neurologist and co-author of the study at University of Rochester Medical Center (URMC).
"However, there has been limited empirical evidence demonstrating that admission to a stroke center is associated with lower mortality. This study shows that designated stroke centers not only have a greater adherence to evidence based practices but they also save lives."
Xian said previous research has shown that the majority of the U.S. population (up to 50 percent) does not have access to a stroke center within one hour. "In our study, we found among those who lived farther away from stroke centers, less than a quarter of them were transported to a stroke center," he said.
"These new findings highlight the potential to improve stroke quality of care and outcomes," said Eric Peterson, MD, study co-author and associate director of the DCRI. "Having an established infrastructure and protocols in place to care for patients makes sense and is now supported by amazing results. These findings also may serve to support similar systems of care models for improving outcomes in other disease states."
Other co-authors include Katia Noyes, PhD, Manish Shah, MD, and Andre Chappel with the University of Rochester Medical Center, Paul Chan, MD, with the Saint Luke's Mid America Heart Institute, and Henry Ting, MD, with the Mayo Clinic. The study received support from the American Heart Association and the Agency for Healthcare Research and Quality.