An ambulance arrives at a hospital emergency room. / PhotoDisc
Hospitals that make an all-out push for faster stroke care get a clot-busting medication to patients more quickly, prevent more in-hospital deaths and are able to send more survivors straight home, rather than to a nursing facility, a new study shows.
The study was conducted in more than 1,000 hospitals and published online Tuesday in the journal JAMA. It provides some of the best evidence that hospitals can hasten stroke care and get better results by adopting several key strategies. Those include getting alerts from ambulance workers when stroke patients are en route and speeding up brain scans, lab tests and medication mixing once patients arrive.
Still, the study suggests such efforts can be for naught if patients show up too late to benefit from the medication ‚?? called tissue plasminogen activator (tPA). Guidelines call for use within 4.5 hours of the first symptoms and within an hour of arrival at a hospital.
The study is "more evidence that for stroke, every minute counts," says lead author Gregg Fonarow, a heart specialist at the University of California-Los Angeles.
Researchers looked at 71,169 patients with ischemic strokes, the kind caused by blood clots. They compared those treated in the years 2003-2009 with those treated in 2010-2013 after the hospitals adopted an improvement program developed by groups including the American Stroke Association.
Result: The share of tPA-treated patients who got the drug within an hour of arriving rose from 26% to 41% and reached 53% by the last months of the study. The median time elapsed fell from 77 minutes to 67 minutes.
In-hospital deaths among the treated patients fell from 9.9% to 8.2%. More of them left the hospital able to walk (45.4% vs. 42.2%), and more went home to recover (42.7% vs. 37.6%). A possible complication, bleeding in the brain, affected fewer patients (4.6% vs. 5.6%).
"From a public health standpoint, these are large differences," Fonarow says. "In the course of this study alone, thousands of lives were saved," and thousands more avoided costly nursing home care.
Andrew Russman, a neurologist at Cleveland Clinic, one of the hospitals in the study, agrees: "You have to think about the number of people involved. There are 800,000 strokes a year, and 87% of them are ischemic strokes." Rapid, appropriate tPA treatment means "thousands more are able to walk" after those strokes, he says.
An editorial accompanying the study says more research is needed to show the improvement programs are cost effective. James Grotta of the Memorial Hermann Hospital in Houston wrote that the study does build the case that improving stroke care means increasing treatment speed.
Patients have a role to play, the experts say. In the new study, as in previous studies, most patients did not end up getting tPA at all ‚?? just 8.1% vs. 5.7% before the improvement programs began - and the "number one reason is that people don't arrive at the hospital on time," Russman says.
Everyone should know the warning signs of stroke and act quickly if they experience them or see them in someone else, he says. "This isn't a wait and see situation," he says. "It's a call 911 and go straight to the emergency room situation."
The stroke association suggests remembering stroke signs with the word FAST, for:
‚?ĘFace drooping ‚?? One side may droop or feel numb; smiles may be uneven.
‚?ĘArm weakness ‚?? One arm may be weak or numb.
‚?ĘSpeech difficulty ‚?? Speech may be slurred, and the person may have trouble repeating a simple sentence.
‚?ĘTime to call 911 ‚?? if you see such signs. Also: check the time, so you know when the first symptoms appeared.
Copyright 2014 USATODAY.com
Read the original story: Hospitals pushing faster stroke care get better results