Brains need oxygen – especially considering that they use 20% of the body’s oxygen, yet only account for 2% of body weight.
A stroke causes the brain to be deprived of oxygen and nutrients, due to a reduced blood supply to the brain.
The CDC describes three main types of strokes:
- Ischemic Stroke – arterial blockage, often by blood clot (87% of stroke)
- Hemorrhagic Stroke – arterial rupture or leak, often hypertension/aneurysm
- Transient Ischemic Attack – short blockage (<5 min.), a warning sign for future stroke
Stroke patients taken to the hospital in the ambulance may be diagnosed and treated more quickly than those who do not. Diagnosing the type of stroke the patient is suffering typically involves several tests, with a CT scan (computed tomography) usually being the first. Ischemic strokes may be treated with a clot busting drug called a thrombolytic, commonly tissue plasminogen activator (tPA), which can be used within 3-4.5 hours from first symptoms or manually with mechanical thrombectomy. Hemorrhagic strokes may be treated with surgery.
Statistics on Stroke in the U.S.
Strokes are the fifth leading cause of death with someone suffering a stroke every 40 seconds, even though 80% of strokes are considered preventable. Findings from a National Center for Health Statistics (NCHS) data brief indicate that direct costs from stroke treatment total $18.8 billion with indirect costs bringing that total to an estimated $34 billion. The NCHS goes on to report that every year, there are nearly 1 million hospitalizations for stroke with over two-thirds of patients being 65 years or older. By the time you finish this paragraph, someone will have suffered another stroke.
3 Strategies to Impact Stroke in your Organization
1. Train Staff on Stroke Identification.
Prompt stroke identification and treatment is key to improve stroke outcomes, decrease long-term care needs, and decrease cost burden. The stroke treatments that work best are only available if the stroke is recognized and diagnosed within 3 hours of onset. Having all staff know the basics of identifying a stoke can improve time to treatment.
Signs of stroke in men and women include sudden numbness or weakness (especially on one side of the body), sudden confusion, sudden trouble seeing, sudden trouble walking or dizziness, and/or sudden severe headache with no known cause. A simple test staff can perform if they notice any of these signs and symptoms can help prevent major permanent disability and even save a life within your hospital or healthcare facility.
F – Face: Ask the person to smile. Does one side of the face droop?
A – Arms: Ask the person to raise both arms. Does one arm drift downward?
S – Speech: Ask the person to repeat a simple phrase. Is the speech slurred or strange?
T – Time: If you see any of these signs, call 9-1-1 right away.
2. Implement Stroke Risk Assessments on Patients.
With stroke greatly impacting the cost and admissions in hospitals, it is imperative that patients, especially those 55 and older, are being evaluated for their possible risk and put on appropriate medications. While hospitals may not be able to take a full population health approach with stroke, unless they are part of a larger comprehensive care system, there is still an ability to improve stroke risk factors on anyone in your facility. Many patients may be admitted or show up in the emergency department without basic primary care, having them readmit for a preventable stroke increases unnecessary healthcare expenditures and decreases patient outcomes.
One in four stroke survivors will have another stroke within five years, which is why treating the underlying causes of stroke is so important. These include heart disease, hypertension, atrial fibrillation, high cholesterol and diabetes. Diet, exercises and other healthy lifestyle habits, in conjunction with medications or surgery, may be prescribed.
3. Make Stroke Data Actionable.
While most hospital systems have access to some dashboards or EHR data to see their performance in measures such as “time to TPA” or stroke readmissions and mortality, it is essential to make this data actionable. Finding a performance management analytics engine that can pinpoint to the clinician where variations in care are occurring, are key to improving leading measures, patient outcomes, and cost of care.
The Future of Stroke Prevention in U.S. Healthcare
Although stroke hospitalization rates have declined, strokes still account for over 1 million hospitalizations. Strokes continue to contribute to high mortality and healthcare expenditures, with approximately 55% of stroke patients requiring additional inpatient care after their acute hospital stay. Depending on the severity of neurologic deficits, the patient will either require outpatient rehab/home care about one to three times per week, short-term intensive therapy with an average length of stay (LOS) around 15.5 days, or less intensive long-term therapy with average LOS of 32.1 days. The incredibly high costs of stroke long-term care is leading to a significant need to impact stroke outcomes.
Polypill vs Personalized Risk Factor Modification
The ultimate goal would be to not only decrease the time from symptom to diagnosis, but also reduce the risk of having the first stroke. Currently, the population approach has targeted behavioral lifestyle modification through educational, societal, and economic measures, which have been largely ineffective due to the considerable limitations.
The two broad approaches to primary stroke prevention are:
- Reduce risk factor distribution in the entire population
- Identify high-risk individuals through screening and then prescribe targeted interventions
Kernan, Launer, and Goldstein, 2010, discussed the merits of a “polypill” approach versus a Personalized Risk Factor Modification approach to reducing the risks of having a stroke.
The “polypill” approach includes prescribing three antihypertensive drugs (a statin, folic acid, and low-dose aspirin) to everyone in the population over the age of 55 and those with heart disease. This approach has the estimated potential to reduce stroke by 80 percent. The argument is that ischemic strokes are substantially preventable, but many persons are unaware they have hypertension/high cholesterol. Therefore, preventing risks before they emerge is generally more effective and adherence is simple with once daily regimens.  However, a European study estimated that the even if the drug regimen was provided for free the “polypill” strategy would provide no cost savings in a total population approach.
The Personalized Risk Factor Modification approach involves designing prevention and treatment approaches based on an individual’s risk. There are several reasons for this approach over “polypill,” including the relatively low prevalence of people having multiple risk factors, the unintended side effects of medications, the risk of drug-drug interactions, and cost.
Prompt stroke identification and treatment combined with stroke prevention strategies reduces the risk for complications and mortalities, as well as the cost of long-term hospitalizations. Improve time to treatment by training your staff on quickly identifying strokes and promote prevention measures, such as stroke risk assessments and accessibility to stroke data.
The American Heart Association (AHA) is dedicated to fighting heart disease and stroke and is the nation’s leader in CPR & Emergency Cardiovascular Care (ECC) education training.
Partnering with AHA, Relias offers healthcare organizations a quick and easy way to consolidate their online training needs by having AHA courses made available directly through the Relias learning management system.