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Survey of State's Hospitals Shows Progress, Areas for Improvement in Diagnosis, Treatment of Stroke

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Duke Health News 919-660-1306

DURHAM, N.C. -– A survey of every hospital in North Carolina has shown that while a new clot-busting drug for the treatment of stroke has gained rapid and wide acceptance, hospitals still have a long way to go in providing additional services that can further improve patient outcomes and reduce the costs of stroke.

The researchers surveyed all 125 inpatient medical facilities in North Carolina and found that 54 can provide treatment with recombinant tissue-type plasminogen activator, known as tPA. Less than two years ago, the Food and Drug Administration (FDA) approved the use of tPA for use in patients with strokes caused by blood clots who could be treated within the first three hours of the onset of symptoms.

While only about 43 percent of the hospital offered tPA, those hospitals served almost three-quarters (74 percent) of the state's population.

Duke neurologist Dr. Larry Goldstein, the survey's author, said he is heartened by the rapid acceptance of tPA across the state because national studies have shown the drug can substantially reduce disability. But he added that the survey points out areas in need of improvement.

"The use of tPA for stroke is easily the biggest advance in the treatment of stroke in the past decade, but it is only effective when used quickly," Goldstein said. "There is a very narrow window of opportunity when using this drug – patients or family members must recognize the symptoms very early and get to the hospital, and physicians must be able to react quickly for it to be effective."

The most common symptoms of stroke include sudden onset of slurred speech, difficulty walking, weakness on one side of the body, blindness in one eye and double vision.

The results of Goldstein's survey were published Thursday (Oct. 8) in the journal Stroke. It was supported by a grant from the North Carolina Department of Health and Human Services, Division of Community Health.

"We were surprised that tPA has been accepted so quickly," Goldstein said. "It shows that physicians do respond quickly to the medical literature. Because stroke is such a big problem in North Carolina, it bodes well for the future. This survey highlights the problems that need to be addressed and where."

While tPA has been shown very effective in the treatment of stroke caused by clots, it can cause bleeding in patients whose stroke is caused by a ruptured vessel. For this reason, before administering the drug, physicians must first perform a CT scan to determine the type of stroke, Goldstein said.

When administered within the first three hours of symptom onset, tPA increases by 10 percent to 13 percent the likelihood that a patient will have no disability after three months, Goldstein said. Since time is crucial, Goldstein was surprised by the low numbers of hospitals that didn't have in place other programs that can speed the process of diagnosing and/or treating stroke, even among those hospitals that offer tPA.

These other services include community awareness programs to educate people about the symptoms of stroke, and the use of stroke teams, care maps and rapid stroke identification teams within hospitals. According to Goldstein, these services aren't necessarily expensive, but require institutional commitment.

"While the hospitals that provided tPA were better in these areas than hospitals that don't offer tPA, there is still much room for improvement," Goldstein said. As an example, he says, only 41 percent of the hospitals offering tPA had community awareness programs while 17 percent of those not offering tPA had such programs.

The survey was a simple one-page questionnaire that Goldstein feels could be used as a model for such surveys throughout the country. It was co-signed by Goldstein and the deputy director of the state Department of Health and Human Services.

"This is the first survey to look at stroke prevention and treatment facilities across an entire state," Goldstein said. "The simple methodology permits the targeting of selected facilities for development of new or additional stroke treatment programs."

More than 500,000 Americans will suffer a stroke each year. Of those, approximately 150,000 will die, making stroke the third leading cause of death and the leading cause of disability. It has been estimated that stroke-related care and lost productivity costs this country more than $30 billion a year.

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