Geographic Access to Acute Stroke Care in the United States

Adeoye, Opeolu; Albright, Karen C.; Carr, Brendan G.; Wolff, Catherine; Mullen, M.; Abruzzo, Todd; Ringer, Andrew J.; Khatri, Pooja; Branas, Charles C.; Kleindorfer, Dawn

doi:10.1161/strokeaha.114.006293

Cited by 177 publications

(144 citation statements)

References 27 publications

(25 reference statements)

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“…In a study of the 2011 US population, only 0.5% of AIS patients underwent EVT, and 56% of them were 60-minute drive away to an endovascular-capable hospital. 7 Health systems need organizational changes to assure that patients who are candidates for EVT can have access to timely adequate care. In Catalonia, a decentralized stroke care model was progressively developed from 2006 to 2013 to ensure rapid access to IV r-tPA, which currently reaches 15% of AIS patients throughout the region.…”

Section: Pérez De La Ossa Et Al Population Endovascular Therapy Rate mentioning

confidence: 99%

Access to Endovascular Treatment in Remote Areas

Ossa¹,

Abilleira²,

Dorado³

et al. 2016

Stroke

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We aim to determine population-based EVT rate, treatment delay, and clinical outcomes by geographical areas in Catalonia, Spain. Methods Study SettingThe region of Catalonia includes a total population of 7.5 million inhabitants and an area of 32 000 km 2 . The Catalan Stroke Program was established in 2006, a Stroke Code system to cover the entire territory of Catalonia, offering acute stroke care in 9 Primary Background and Purpose-Since demonstration of the benefit of endovascular treatment (EVT) in acute ischemic stroke patients with proximal arterial occlusion, stroke care systems need to be reorganized to deliver EVT in a timely and equitable way. We analyzed differences in the access to EVT by geographical areas in Catalonia, a territory with a highly decentralized stroke model. Methods-We studied 965 patients treated with EVT from a prospective multicenter population-based registry of stroke patients treated with reperfusion therapies in Catalonia, Spain (SONIIA). Three different areas were defined: (A) health areas primarily covered by Comprehensive Stroke Centers, (B) areas primarily covered by local stroke centers located less than hour away from a Comprehensive Stroke Center, and (C) areas primarily covered by local stroke centers located more than hour away from a Comprehensive Stroke Center. We compared the number of EVT×100 000 inhabitants/year and time from stroke onset to groin puncture between groups. Results-Baseline characteristics were similar between groups. Throughout the study period, there were significant differences in the population rates of EVT across geographical areas. EVT rates by 100 000 in 2015 were 10.5 in A area, 3.7 in B, and 2.7 in C.

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Section: Pérez De La Ossa Et Al Population Endovascular Therapy Rate mentioning

confidence: 99%

Access to Endovascular Treatment in Remote Areas

Ossa¹,

Abilleira²,

Dorado³

et al. 2016

Stroke

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“…In a study of the US population, Adeoye et al reported that 19% reside more than 60 minutes from IV-tPA capable centers, half more than 60 minutes from endovascular-capable centers by ground transport, and 15% more than 60 minutes from endovascular-capable centers by air transport (assuming its availability). 1 In just over 2 decades, advancement in catheter-based endovascular technologies has revolutionized AIS care. These catheter technologies inspired a completely new paradigm for the treatment of AIS.…”

mentioning

confidence: 99%

Application of emerging technologies to improve access to ischemic stroke care

Vuong

Carroll

Tackla

et al. 2017

Neurosurgical Focus

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During the past 20 years, the traditional supportive treatment for stroke has been radically transformed by advances in catheter technologies and a cohort of prominent randomized controlled trials that unequivocally demonstrated significant improvement in stroke outcomes with timely endovascular intervention. However, substantial limitations to treatment remain, among the most important being timely access to care. Nonetheless, stroke care has continued its evolution by incorporating technological advances from various fields that can further reduce patients' morbidity and mortality. In this paper the authors discuss the importance of emerging technologies—mobile stroke treatment units, telemedicine, and robotically assisted angiography—as future tools for expanding access to the diagnosis and treatment of acute ischemic stroke.

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“…rt‐PA has been shown to improve outcomes of survival and independence 7, 8, 12, 13, 14, 15. However, its use is limited by the very short window of opportunity for treatment and risk of bleeding, making less than 6% of stroke patients eligible for such treatment 16, 17. In a pooled analysis, the NNT for achieving an mRS score of 0 to 1 was 4.5 for OTT of <90 minutes, 9 for OTT 91 to 180 minutes, and 14 for OTT 181 to 270 minutes 8.…”

Section: Discussionmentioning

confidence: 99%

The value of patient selection in demonstrating treatment effect in stroke recovery trials: lessons from the CHIMES study of MLC601 (NeuroAiD)

Venketasubramanian

Lee

Wong

et al. 2015

Journal of Evidence-Based Medicine

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ObjectiveThe CHIMES Study compared MLC601 to placebo in patients with ischemic stroke of intermediate severity in the preceding 72 hours. We aimed to verify if patient selection based on two prognostic factors (ie, stroke severity and time to treatment) improves detection of a treatment effect with MLC601.MethodsAnalyses were performed using data from the CHIMES Study, an international, randomized, placebo‐controlled, double‐blind trial comparing MLC601 to placebo in patients with ischemic stroke of intermediate severity in the preceding 72 hours. Three subgroups, that is, onset to treatment time (OTT) ≥48 hours; baseline National Institute of Health Stroke Scale (NIHSS) ≥10; both OTT ≥48 hours and baseline NIHSS ≥10, were analyzed using modified Rankin Scale (mRS) ≤1 and a composite endpoint of mRS ≤1, Barthel Index ≥95, and NIHSS ≤1 at month 3.ResultsPlacebo response rates were lower (ie, worse natural outcome) among subgroups with prognostic factors. Conversely, MLC601 treatment effects were significantly higher in the subgroups with prognostic factors than for the entire cohort, being highest among patients with both OTT ≥48 hours and baseline NIHSS of 10 to 14: odds ratios of 2.18 (95% CI 1.02 to 4.65) for month 3 mRS ≤1 and 3.88 (95% CI 1.03 to 14.71) for the composite endpoint.Conclusions: Patients who have moderately severe strokes and longer OTT demonstrate better treatment effects with MLC601. These factors can guide patient selection in future trials.

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Geographic Access to Acute Stroke Care in the United States

Cited by 177 publications

References 27 publications

Access to Endovascular Treatment in Remote Areas

Access to Endovascular Treatment in Remote Areas

Application of emerging technologies to improve access to ischemic stroke care

The value of patient selection in demonstrating treatment effect in stroke recovery trials: lessons from the CHIMES study of MLC601 (NeuroAiD)

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