Location may affect quality of care for a stroke

ANN ARBOR, Mich., June 26 (UPI) -- Where you have a stroke may determine whether you are treated soon enough with so-called "clotbuster" drugs that restore blood flow to the brain and prevent stroke-related paralysis and disability, according to a new study.

Researchers looked at how tissue plasminogen activators, or tPA, or other emergency stroke treatments, were used at hospitals in the U.S., finding that as few as zero stroke patients in some areas received the drugs.

Emergency treatments like tPA can restore blood flow in the brain and prevent the damage that causes stroke-related disability, which drives up the long-term cost of care for stroke survivors. Researchers say thousands of people a year may end up unnecessarily disabled as a result of not receiving the drugs.

"We can clearly do much better, but existing policy solutions are only going to get us so far," said James Burke, M.D., M.S., an assistant professor in neurology at the University of Michigan and the VA Ann Arbor Healthcare System, in a press release. "In our findings, we do see positive results from primary stroke center designation and ambulance bypass, but we are talking about a complex mix of hospital, EMS, and individual response to stroke."

The study included data on Medicare patients with ischemic stroke who arrived at emergency rooms between 2007 and 2010, with data broken down into 3,436 hospital markets. Only 4.2 percent of more than 844,000 stroke patients received tPA. Stanford, Conn., and Asheville, N.C., had the highest rate of use as 14 percent of patients received of some form of emergency stroke treatment.

Comprehensive stroke center designations were not in use during the time the data was collected, and the most advanced levels of emergency stroke treatment may not have been in widespread use. The data showed, however, that in areas where primary stroke centers existed at the time their existence did not effect whether tPA was used.

According to researchers, tPA use was lower in areas with lower average levels of education and income, and higher unemployment, while use was slightly higher in densely populated areas. The top 20 areas for use, however, were found to be a mix of rich and poor communities.

"By studying communities that treated a lot of stroke patients, we may learn how best to help low-performing communities treat more acute stroke patients in their community," said Lesli Skolarus, M.D., a stroke neurologist and assistant professor at the University of Michigan.

The study is published in the journal Stroke.