Many in U.S. live too far from advanced stroke care

(Reuters Health) - Many Americans would not have quick access to the best healthcare options during a stroke, even under the most ideal circumstances, according to a new computer model.

In a hypothetical model, if each state had up to 20 hospitals providing the best possible care for people having strokes - which is not the current reality - more than a third of Americans would still be more than a 60-minute ambulance ride away from one of those medical centers.

Using a helicopter or other air transportation would improve that number but still leave many Americans more than an hour away from the nearest center, the study found.

“There are effective treatments for stroke, but they are time sensitive,” said lead author Dr. Michael Mullen. “The faster a patient is treated, the more likely they are to be eligible for acute stroke therapies and the more effective those therapies will be.”

Timely transport to a qualified medical center is especially important with recent evidence supporting a new method to clear stroke-causing blood clots from the brain, said Mullen, a neurologist from the Perelman School of Medicine at the University of Pennsylvania in Philadelphia, in an email to Reuters Health.

That procedure, he said, “is resource intensive and will not be available in all hospitals.”

Starting in 2003, medical centers could be certified as primary stroke centers, making them go-to hospitals for stroke patients. Starting in 2012, they could also be certified as comprehensive stroke centers to show they deliver the most advanced stroke care.

For the new study, the researchers used a computer model to show which primary stroke centers should be upgraded to comprehensive centers to optimize access for as many Americans as possible.

By the end of 2010, there were 811 primary stroke centers that were potential candidates for upgrade, the researchers report in the journal Neurology.

Each state had between 0 and 96 primary stroke centers, and only about 66 percent of Americans were within a one-hour ride to one of those centers, they found.

Under what the researchers consider a best-case scenario, converting up to 20 of those hospitals in strategic locations in each state would give about 63 percent of Americans access to a comprehensive stroke center within an hour drive.

By adding air transportation as an option to those centers, 86 percent of Americans would be an hour away from one of the comprehensive stroke centers.

Even so, access would vary considerably by state. Everyone in most Northeastern states would have access to a comprehensive stroke center by ground or air within 60 minutes, compared to only about 15 percent of people in Wyoming.

“I think that the primary take-away is that even under optimal circumstances Comprehensive Stroke Centers may not be rapidly accessible to everyone in the population and there will likely be significant geographic variability in access to these centers,” Mullen said.

The researchers caution that comprehensive stroke centers are new and still need to show that they deliver better care than traditional hospitals.

One neurologist not involved with the study said the current approach to stroke care has elements in common with approaches used in trauma care and for heart attacks.

For heart attacks, Dr. David Miller said, many hospitals can provide initial care and then transfer patients to other hospitals - but trauma patients are usually taken directly to regional centers that provide very advanced care.

“Stroke is in-between,” said Miller, director of the comprehensive stroke center at the Mayo Clinic in Jacksonville, Florida.

As of now, he said, the most important thing is for people experiencing the symptoms of stroke to get medical attention and notify 911.

“If it’s a small emergency room that’s a block away, you get them there,” Miller said.

The American Stroke Association recommends FAST to identify the symptoms of a stroke: Face drooping, Arm weakness, Speech difficulty, Time to call 911.

SOURCE: bit.ly/17Wc79e and bit.ly/17Wc9Ow Neurology, online March 4, 2015.

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