Association publishes blueprint to strengthen stroke care from prevention through recovery

to smaller, underserved facilities by relying more heavily on telemedicine-enabled consultations that overcome the boundaries of time and distance, and help rural hospitals tap into urban resources.

Physicians can use "TeleStroke" consults on stroke patients with hospitals in small communities using high-speed videoconferencing and imaging links that can transmit interactive clinical and brain scan data directly to physician's office.

Because many who experience a stroke will be unable to call for help on their own, prevention includes community education programs to increase stroke systems and help the public understand the symptoms of stroke. One example is the two-year-old public service campaign by the American Stroke Association and the Ad Council that uses television ads, featuring celebrities, to alert viewers to the symptoms and damage caused by stroke.

The drug tissue plasminogen activator (tPA) is a clot buster used for ischemic stroke, which is caused by blocked arteries in the brain. The drug is approved for use during a three-hour window of symptom onset before brain damage becomes irreversible. For patients to receive tPA, they must get to a hospital soon after their symptoms begin. Hospital staff must be able to rapidly evaluate the patient and perform the brain imaging and interpretation that will rule out other conditions such as seizure disorders, brain infections, brain swelling, tumors or hemorrhagic stroke (bleeding in the brain), Schwamm said.

Many rural hospitals lack the support needed to give tPA, such as immediate access to radiologists and neurologists who can image the brain and interpret the results. Telemedicine can make that happen. "Treating patients early with tPA reduces disability, which saves money. A cost-benefit analysis suggests that you save $4,000 for every patient treated with tPA," Schwamm said.

Arthur Pancioli, M.D., an associate professor at the University of Cincinnati (Ohio) an

Contact: Carole Bullock
American Heart Association

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