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Stroke centers are life savers. In first 90 minutes

Staff Writer |
The odds of surviving a stroke are slightly better for patients treated at hospitals with a specialized stroke department, known as primary stroke centers, a new study finds.

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But that benefit was only seen if stroke patients got to a stroke center in less than 90 minutes, the study authors said.

"Treatment of stroke is very time sensitive. As the saying goes, time is brain," said lead researcher Dr. Kimon Bekelis. "So the faster you intervene, the faster the patient recovers," he said.

Bekelis is an instructor at the Dartmouth Institute for Health Policy and Clinical Practice at Dartmouth-Hitchcock Medical Center in Lebanon, N.H.

Primary stroke centers provide integrated care, including timely administration of medications, such as the clot-busting drug tPA (tissue plasminogen activator, also known as alteplase). They also offer special procedures to reduce the effects of a stroke, Bekelis said.

Many of these treatments are only available at stroke centers or are delivered faster there, which may account for the difference in survival, compared with treatment at a community hospital, he said.

Most Americans live within 90 minutes of a stroke center, but in rural areas the travel time can be longer, Bekelis said. He suggested that to fill this gap, speeding travel time using helicopters might be one way of improving survival.

Dr. Ralph Sacco is chairman of neurology at the University of Miami Miller School of Medicine. He said, "This analysis provides further evidence of the importance of being treated for stroke at a certified primary stroke center, even if it takes up to 90 minutes to get there."

The study only looked at differences in death rates for stroke centers compared to standard hospitals. But, it's likely there are other potential benefits - such as reduced disability - for patients treated in certified stroke centers, Sacco suggested.

"Longer delays in getting to a stroke center might lead to decreases in the utilization of acute stroke treatments," he explained.

"We need to consider other approaches, such as the use of telestroke [which puts doctors who are treating a stroke patient in direct contact with a stroke specialist using technology], and increasing the number of stroke-ready hospitals to increase the access of patients to timely stroke care," Sacco said.

For the study, the researchers collected data on nearly 866,000 Medicare patients, average age 79. All had a stroke between 2010 and 2013.


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