Thursday, June 2, 2011

Study Shows Link Between State Stroke Program and Number Of Designated Centers

May 25, 2011 (Washington, DC) —The size of a hospital and the population it serves, as well as being located in a state that has a program for stroke center certification, are among factors that contribute to whether an institution becomes a certified stroke center, a new study shows.

"The study demonstrates that having a state stroke program increases the number or percentage of stroke centers, and that's good thing," said lead study author Ken Uchino, MD, a stroke neurologist and staff physician at Cerebrovascular Center, Cleveland Clinic, in Ohio, and director, Vascular Neurology Fellowship Training Program. "One take-home message is that if all the states had such a program, we could probably increase the number of stroke centers across the country."

The study was presented during a poster session at the American Heart Association's Quality of Care and Outcomes Research 2011 Scientific Sessions in Washington, DC.

For this report, Dr. Uchino and his colleagues searched public databases for primary stroke centers certified by national organizations or state health departments. They calculated the proportion of primary stroke centers within hospitals in each state and analyzed the relationship to geography and state programs for stroke center certification.

Of 4521 acute care general hospitals across the country, 24% (1067) are stroke certified, they found. The percentages range from 0% to 98% among the 50 states and District of Columbia.

The researchers found that geography plays a role in determining the chances of a hospital being a certified stroke center. More stroke centers are located in the North and East and fewer in the South and West.

The size of the hospital in terms of the number of beds and admissions, as well as the population it serves, also positively influenced the rate of stroke centers across the country.

But another important factor is having a state health department program in stroke systems of care, which increases the likelihood of hospitals being a certified stroke center, they report. A median of 63% (range, 20% – 98%) of hospitals in the 8 states that have such a program are designated stroke centers compared with a median of 13% (range, 0% – 80%; P < .001) in states without such a program.

This indicates that even some small hospitals in areas that have a stroke program have designated stroke center status. "It means that this state program gives a little push or some incentive," said Dr. Uchino. "Some hospitals may not want to lose patients, and they go out of their way to get certified. I think it encourages even smaller hospitals to be certified."

Of the 8 states with a stroke program, 4 (Massachusetts, Connecticut, New Jersey, and New York) are located in the Northeast, a region that tends to have more large urban areas than other parts of the country. However, not all of these 8 states are extensively urban; for example, Oklahoma "has a couple of big cities but is not a densely populated state," noted Dr. Uchino.

The other states with stroke programs are Texas, Florida, and Virginia.

Mounting research demonstrates that the mortality rate is lower in stroke centers compared with nonstroke centers. Dr. Uchino cited a recent paper (JAMA. 2011;305:373-380) that found that among patients with acute ischemic stroke, admission to a designated stroke center was associated with modestly lower mortality rates and more frequent use of thrombolytic therapy.

The current study also found that stroke centers that were certified by a state program without Joint Commission certification were smaller in terms of the number of beds compared with those centers certified by the Joint Commission.

Reached for a comment, Ralph Sacco, MD, professor and chairman of neurology, chief of neurology, Jackson Memorial Hospital, University of Miami, Miller School of Medicine, in Florida, and president of the American Heart Association, stressed that stroke centers are the most effective way to help improve outcomes for stroke patients.

"Some states have helped organize stroke systems better than others," he told Medscape Medical News. "In some states, stroke champions have helped push a stroke agenda, and in others, we have more work to do. The American Heart Association/American Stroke Association is trying to advocate through state legislatures for better organized stroke systems."

The number of stroke centers across the country has increased, but as the population ages, more will be needed to care for the growing number of people who will have a stroke, said Dr. Sacco.

"Too few patients with stroke get treated with acute stroke therapy, and only through improving our stroke systems of care can we improve the treatment of stroke," he said.

Dr. Uchino has disclosed no relevant financial relationships.

American Heart Association's Quality of Care and Outcomes Research 2011 Scientific Sessions: Poster 280. Presented May 14, 2011.

It's CPR Awareness Week!

June 1-7 is National CPR and AED Awareness Week. The American Heart Association believes that everyone should be trained in CPR because simply put CPR + AEDs = Saved Lives.

One strategy that is becoming more popular is to incorporate CPR training with school curriculum. CPR training in Oklahoma schools makes perfect sense if we want to prepare students for health emergencies. They can learn how to recognize cases of sudden cardiac arrest and be prepared to save lives.

Please consider these facts:
-About 5,920 children 18 years old and under suffer out-of-hospital cardiac arrest each year from all causes -- including trauma, cardiovascular causes and sudden infant death syndrome.
-Less than 8 percent of people who suffer cardiac arrest outside the hospital survive to make it home from the hospital.
-Sudden cardiac arrest can happen to anyone at any time. Many victims appear healthy with no known heart disease or other risk factors.
-Effective bystander CPR, provided immediately after sudden cardiac arrest, can double or triple a victim's chance of survival.

Please log on to and contact your lawmaker today to tell them we need CPR training in our schools.

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