How Hospitals Can Reduce Disabilities For Stroke Patients

Research finds when hospitals initiate rapid response programs to treat stroke victims, response time is cut and fewer patients die. The stroke patients also have fewer significant disabilities.

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RENEE MONTAGNE, HOST:

And let's get some health news now. New studies about recovery from strokes appear in this week's Journal of the American Medical Association. The research suggests hospitals can save lives and reduce disability after a stroke if they put targeted new programs in place to speed up treatment. NPR's Patti Neighmond has more.

PATTI NEIGHMOND, BYLINE: For stroke patients, time is everything. The sooner a stroke is identified the sooner treatment begins, the more likely patients will recover without disability. The treatment called TPA stands for tissue plasminogen activator. UCLA cardiologist Gregg Fonarow says it works in strokes caused by blood clots by dissolving the blockage.

GREGG FONAROW: And if you can re-establish that blood flow early in the course of an acute ischemic stroke, you can save brain. So it really is so much true that, you know, time loss is brain loss.

NEIGHMOND: National guidelines recommend patients get TPA within about four hours from when symptoms begin, and within one hour after they arrive at the hospital. But Fonarow says before the new fast track program, not even a third of the patients who could benefit were getting the medication that fast in the hospital.

FONAROW: The earlier that its been given, the greater the benefits that have been seen in clinical trials.

NEIGHMOND: Which is why Fonarow and colleagues launched a program in more than 1,000 hospitals nationwide with strategies like...

FONAROW: When the patient was being transported by emergency medical services that they notified the hospital that a stroke patient was on the way. And that gave the stroke team the opportunity to be pre-activated and meet that patient in the emergency department.

NEIGHMOND: And having the MRI or CT machines ready, so when patients arrive, doctors can quickly identify where the stroke is and whether the patient would benefit. Another strategy...

FONAROW: Storing the TPA right there in either the ER or where the brain scan was done, so nobody had to go off to the pharmacy and have a delay in getting the drug right there to the bedside of the patient.

NEIGHMOND: In Fonarow's study, after the fast track program started, hospitals on average saved 15 crucial minutes. Bringing the overall time it took from when the patient entered the hospital to when they received TPA, down to the recommended one hour. Fonarow says there were fewer deaths and less disability as a result.

GLORIA SCHAFFER: I just feel so blessed.

NEIGHMOND: Gloria Schaffer was 59 years old this past New Years Day, when she was driving home with her husband after a day of shopping and dinner.

SCHAFFER: I started feeling symptoms which would be similar to a vertigo. I started feeling a little bit dizzy and nauseated. And I do remember feeling in my eyes, like a strobe light.

NEIGHMOND: Schaffer knew that if this was a stroke she had to get to a hospital fast. And she did. Doctors at UCLA were already implementing fast track evaluation. She received TPA within the recommended hour. Today, just four months later, Schaffer feels well on the road to complete recovery.

SCHAFFER: I would say I'm probably 70 percent, in my brain, recovered. I was a, you know, the consummate multi-tasker - waking up early in the morning. And right now, you know, I just have to take it slow and its fine.

NEIGHMOND: Schaffer knows she's lucky. Cardiologist Fonarow says the study should encourage even more hospitals to fast track TPA.

In another study in the journal, German researchers were able to reduce hospital door to TPA injection time even more. By outfitting an ambulance with imagining machines and TPA, essentially bringing the hospital stroke unit to the patient. That sped up treatment by an average of 25 minutes. Such sophisticated fast response would cost more. But cardiologist Fonarow says it's a goal worth shooting for.

Patti Neighmond, NPR News.

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