Despite benefit, hospitals not always alerted of incoming stroke patients
DALLAS, July 10, 2012 (GLOBE NEWSWIRE) -- Treatment is delivered faster
when emergency medical services (EMS) personnel notify hospitals a
possible stroke patient is en route, yet pre-notification doesn't occur
nearly one-third of the time. That's according to two separate Get With
The Guidelines(R)-- Stroke program studies published in American Heart
The American Heart Association/American Stroke Association recommends
EMS notify hospitals of incoming stroke patients to allow stroke teams
to prepare for prompt evaluation and treatment. Quick response is vital
for stroke patients, particularly those with ischemic stroke, when a
clot cuts off the blood supply to a portion of the brain. Clot-busting
drugs can only be given within a limited time -- three to 4.5 hours
after the onset of symptoms.
For both studies, researchers examined the records of 371,988 acute
ischemic stroke patients transported by EMS to one of 1,585 hospitals
participating in the Get With The Guidelines--Stroke quality
improvement program between 2003 and 2011.
Pre-notification of hospital by EMS resulted in faster diagnosis and
treatment for stroke patients, according to the study published in
Circulation: Cardiovascular Quality & Outcomes.
Pre-notification was independently associated with better treatment
-- arrival-to-imaging times of 25 minutes or less,
-- arrival-to-treatment with the clot-busting drug tPA within 60 minutes,
-- symptom onset-to-tPA treatment times of 120 minutes or less,
-- and more eligible patients treated with tPA.
However, pre-notification occurred in only 67 percent of patients in
2011, only a modest increase from the 58 percent in 2003, according to
the study published in the Journal of the American Heart Association
"Despite national guidelines recommending pre-notification by EMS for
acute stroke patients, it's disappointing that there's been little
improvement," said Gregg C. Fonarow, M.D., senior author of both
studies and professor of cardiovascular medicine at the University of
California-Los Angeles. "However, with these powerful new findings
demonstrating substantial benefits with pre-notification, we have a
tremendous opportunity to make positive changes in this component of
Among patients arriving within two hours of symptom onset, patients
with EMS pre-notification were more likely to:
-- be treated with tPA within three hours (82.8 percent vs. 79.2 percent);
-- have shorter arrival-to-imaging times (26 minutes vs. 31 minutes);
-- have shorter arrival-to-tPA treatment times (78 minutes vs. 80 minutes);
-- have shorter symptom onset-to-tPA treatment times (141 minutes vs. 145
The researchers found dramatic variations in pre-notification rates:
-- Rates ranged from 0 percent to 100 percent among individual hospitals.
-- Rates were higher in non-academic hospitals and those that more
frequently use tPA.
-- States and regions also varied widely, from 93.4 percent in Montana to
19.7 percent in the District of Columbia.
-- Rates were lower in the northeast.
"The large variations by state and hospital are really striking and
should be a concern because the potential for ideal patient care isn't
being met," Fonarow said. "We've developed a map of rates by state.
This tool can identify areas that are most in need of improved stroke
Furthermore, EMS pre-notification was significantly less likely if
patients were older, black or had a prior history of stroke, diabetes
or peripheral vascular disease (clogged leg arteries).
"This tells us what we need to target EMS education," Fonarow said.
"These patients are at higher risk for stroke and other ailments and
may present challenges to EMS determining in the field whether their
symptoms represent stroke. The goal is that EMS provides advanced
notification for every potential stroke patient being transported."
The studies included only data from Get With The Guidelines--Stroke
hospitals. However, these comprise about one-third of U.S. hospitals
and are considered representative of all hospitals in terms of
pre-hospital care, Fonarow said.
The Get With The Guidelines--Stroke program is supported in part by a
charitable contribution from Janssen Pharmaceutical Companies of
Johnson & Johnson. The program has been funded by Boeringher-Ingelheim,
Merck, Bristol-Myers Squib/Sanofi Pharmaceutical Partnership and the
American Heart Association Pharmaceutical Roundtable.
Call 9-1-1 if you or someone you're with experiences stroke warning
signs. Use this map to find an American Heart Association/American
Stroke Association-certified stroke center near you.