Study examines stroke care

Most stroke patients arrive at a hospital too late to receive the best treatment for their symptoms. But once they arrive, a Yale study found, more patients are getting the correct drug than ever before.

In 2004, only about 37 percent of stroke victims arrived at a hospital soon enough to receive tissue-type plasminogen activator (t-PA), a drug which dissolves blood clots. The drug only works up to three hours after the stroke, the study reported.

But more hospitals are using t-PA than ever before. In 2004, 38 percent of stroke victims who arrived in time received the drug, up from 14 percent in 2001.

The study, which will be published in the December 2009 edition of “Stroke: Journal of the American Heart Association,” analyzed data from the medical records of stroke patients at 35 U.S. hospitals in 2001 and 32 hospitals in 2004. The hospitals, which participated in the University HealthSystem Consortium Ischemic Stroke Benchmarking Project, provided information on when patients arrived at the hospital after their stroke.

Lead researcher Judith H. Lichtman SPH ’88 GRD ’96, an associate professor at the Yale School of Public Health, said that despite national campaigns to raise awareness of stroke symptoms, the results of the study show that these drives have had little impact.

Because stroke symptoms — sudden numbness or weakness on one side of the body, confusion, trouble seeing or walking, and severe headaches — often resemble symptoms of less severe diseases, many people are not aware that they have suffered a stroke until it is too late.

“Patients are often embarrassed to be incorrect or dissuaded for economic reasons,” Lichtman said. “We need to figure out how to give them more self-confidence.”

Race was also a factor in delay of treatment. The study found that black patients were only 44 percent as likely as white patients to arrive at the hospital in time to receive t-PA. But new programs, such as the American Heart Association’s Power To End Stroke campaign, have increased awareness of stroke symptoms in the black community, Lichtman said.

Yale-New Haven Hospital has launched its own efforts to raise stroke awareness. Y-NH Hospital Stroke Center Clinical Director Joseph Schindler said most hospitals in Connecticut lack doctors with neurological expertise, which affects stroke treatment. In late 2008, Y-NH Hospital announced that it would provide video consultation on stroke diagnosis to Lawrence & Memorial Hospital in New London, Conn.

A group of Y-NH Hospital volunteer nurses, called the Stamp Out Stroke team, provides on-site assessment of stroke risk at health fairs, said Karin Nystrom NUR ’04, the clinical coordinator for the Y-NH Hospital Stroke Center.

Lichtman and study co-author Emi Watanabe SPH ’06 said they hope their study will encourage other researchers to study long-term trends in stroke treatment.

“If you can connect more than one data period, you can really see if you are going in one direction or if you’re not really going anywhere,” Lichtman said. “Being able to study patterns is very important.”

Comments