A study recently published in the journal Stroke suggests that there may be a wide geographical variation in the use of the stroke treatment tPA.
According to a release from the University of Michigan (U-M) Health System, researchers looked at how tPA was used—or not—in Medicare participants who experienced strokes in each of the nation’s 3,436 hospital markets between 2007 and 2010.
Per their findings, only 4.2% of the 844,000 stroke victims in the United States during the study period received tPA or another urgent stroke treatment.
Also according to the release, in one-fifth of the regions that the researchers studied, no patients received tPA.
Meanwhile, per the release, in places like Stanford, Calif, and Asheville, NC, as many as 14% of stroke patients received tPA through an intravenous line, or a direct-to-brain (intrarterial) treatment that involved tPA or another strategy.
“These results scream that a major opportunity exists to improve emergency stroke care, if only we can understand how these differences arise and how to eliminate them,” says James Burke, MD, MS, the study’s senior author and an assistant professor in neurology at U-M and the VA Ann Arbor Healthcare System, in the release.
“If we had a perfect system in place nationwide, which delivered treatment at the highest rates seen in this study, thousands of patients could be spared disability,” Burke continues in the release.
When the researchers grouped the regions from best-performing to poorest-performing, and looked at them more closely, they found that in the top fifth, an average of 9% of patients got clot-busting treatment, while the bottom fifth, no patients received it, per the release.
Even after they adjusted for the number of strokes that each region reported during the study period, there was a wide gap in use of emergency stroke treatment. In addition, older patients, women, and members of racial and ethnic minority groups were less likely to receive tPA no matter where they lived, the release explains.
And while patients were somewhat more likely to get tPA if they had their strokes in regions where hospitals were certified as primary stroke centers, which can deliver tPA around the clock, or where ambulance companies had a policy of driving stroke patients further to get to a stroke center, those factors didn’t make a major difference, according to the release.
“We can clearly do much better, but existing policy solutions are only going to get us so far,” Burke says in the 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. We need to understand better what the areas with the highest rates of use are doing differently.”
At the time of the study’s data, comprehensive stroke center designation—which indicates the most advanced level of stroke care, including intrarterial tPA—was not yet in use, per the release.
The researchers calculated that if all regions achieved the same rates of tPA use as the Stanford region, more than 92,800 people would get treated, and 8,078 people would survive their stroke disability-free. Even if all regions doubled their current tPA use, 7,206 people would be spared disability, the release explains.
Variation in tPA use did track to lower average levels of education and income, and higher unemployment, in hospital service areas, and use was slightly higher across all densely populated areas compared with more sparsely populated areas, per the release.
But the top 20 areas for tPA use are scattered across the country, in urban and rural areas, rich and poor ones, the release continues.
“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,” says the study’s first author Lesli Skolarus, MD, a stroke neurologist and assistant professor at U-M, in the release.
[Source(s): University of Michigan Health System, EurekAlert]