Use of telemedicine to manage severe ischaemic strokes in a rural area with an elderly population

Abstract

The rural district of the Meuse (East France) has a high number of elderly patients for whom prognosis of ischaemic strokes is poor with high-haemorrhagic transformation risk of intravenous tissue plasminogen activator (rt-PA). This disadvantage is made worse by the distances a patient has to travel to the nearest stroke unit. We set out to assess the effectiveness of a telestroke system implemented in this area. Between October 2010 and February 2012, data from each "tele-expertised" patient were collected. 53 patients were examined. Diagnosis of ischaemic stroke was confirmed in 43 cases (81 %), and intravenous rt-PA treatment performed in 21 cases (40 %). In the treated patient group, median age was 73 years, with 29 % of octogenarians. Baseline National Institutes of Health Stroke Scale (NIHSS) was 16, with 29 % ≥ 20. The median onset to needle time was 169 min, and the median door to needle time was 69 min. Intracranial haemorrhage occurred in 3 cases (14 %), and was symptomatic in two (10 %). At 3 months, median NIHSS was 6, 6 patients (29 %) presented a favourable outcome (modified Rankin scale ≤ 1) and 3 (14 %) had died. In rural areas, for elderly patients with severe ischaemic strokes, telemedicine appears to be a way of improving accessibility and benefits of rt-PA treatment.

Medical service demands of older patients in different age groups in a new model of free Telemedicine

“…It can provide more reliable, professional, e cient and convenient medical services for the older patients in the suburbs. Richard S, et al found telemedicine was an effective way to improve accessibility and bene ts of reducing the risk of intravenous tissue plasminogen activator treatment of older patients with severe ischemic strokes in rural areas [16]. In our study, it was found that cerebral infarction was the third of the top ve major diseases in the young older patients and the fth of the top ve major diseases of the old older patients applying for telemedicine.…”

Intravenous thrombolytic therapy for ischemic stroke via telemedicine compared with bedside treatment in an experienced stroke unit

“…For this reason, "telestroke" systems -based on clinical evaluation and analysis of cerebral imaging by an expert centre via telecommunication with the patient admitted to the nearest local hospital -have been developed in some areas of France, such as the Meuse, a rural district located at more than one hour from a stroke unit. An observational study about telestroke in this area describing demographic data, times to treatment and patient outcomes has already shown similar results to those found in the literature [5]. In this paper we compare the results of rt-PA treatment in patients with ischemic stroke managed through this system to those obtained in patients managed at the bedside in the expert centre of the stroke unit of Nancy.…”

“…Patients living in rural and depopulated areas far from stroke units are thus disadvantaged as they may have to travel a considerable distance before receiving intravenous rt-PA or, even worse, could be excluded from receiving rt-PA if they arrive at the unit too long after stoke onset. This problem is all the more critical as patients in rural areas are typically elderly and present more serious strokes [5]. In this setting, telemedicine constitutes a solution to improving access to expertise and treatment by expanding the reach of specialists to persons beyond their own geographic location and shortening time to treatment initiation [6][7][8].…”

Tele-health-care in the elderly living in nursing home: the first Sicilian multimodal approach

“…A similar result was also found in our study, since the mean heart rate and blood pressure values of the elderly undergoing telemonitoring were significantly lower than those receiving standard cares. Thus, such e-health services may be recommended as part of a better management regimen for the elderly people care [23,24], especially when living in rural areas or nursing home [25,26].…”