(Stroke. 2001;32:1692.)
© 2001 American Heart Association, Inc.
Letters to the Editor |
Addressing Healthy People 2010 Objectives for Stroke
1 Department of Epidemiology,
School of Public Health,
University of North Carolina,
Chapel Hill, North Carolina,
2
Department of Emergency
Medicine,
School of Medicine,
University of North Carolina,
Chapel Hill, North Carolina,
3
North Carolina Department of
Health and Human Services,
Division of Public Health,
Raleigh, North Carolina
To the Editor:
Healthy People 2010 objectives were set for the United States to improve patient knowledge of early warning symptoms for stroke (objective 12-8) and myocardial infarction (MI; objective 12-2). Objectives were also established to emphasize the importance of calling 911 for emergency care for MI (objective 12-2) and to increase the proportion of eligible MI patients who receive thrombolytic therapy within 1 hour of symptom onset (objective 12-3).1 However, corresponding objectives for stroke (ie, calling 911 and increasing the proportion of ischemic stroke patients who receive thrombolytic therapy) were not included. We are writing to recommend that although these corresponding objectives for stroke were not established, they are very important and should also be evaluated.
In the United States, stroke is the third leading cause of mortality.2 The American Heart Association recommends thrombolytic therapy treatment for ischemic stroke within 3 hours of the onset of symptoms.3 A potential benefit of this therapy is to reduce functional limitations resulting from the stroke,4 which may be considerable, as stroke is also the leading cause of neurological disability.5 However, most stroke patients arrive at the hospital too late to even be considered for thrombolytic treatment. A review of 48 published studies on prehospital stroke delay indicates that for most studies, the median time from symptom onset to arrival in the emergency department is 3 to 6 hours.6 For stroke patients, the use of emergency medical services (EMS) is associated with earlier time to hospital arrival,7 8 9 10 11 12 13 time to emergency physician evaluation,7 8 11 14 15 time to a CT scan,8 14 and time to neurology consultation.8 Yet, EMS remains underutilized for stroke patients as well.8 10 Interventions are needed to increase the use of 911 for both stroke and MI symptoms. Improvements are also needed to minimize prehospital delay and optimize care for these patients. The Healthy People 2010 document suggests focusing resources toward those individuals at greatest risk for future cardiovascular events, which is where targeted efforts might derive the greatest benefit.1
To evaluate these efforts, surveillance systems are needed to assess EMS use and prehospital delay time for both stroke and MI patients. Each of the Healthy People 2010 objectives that we cite (12-2,12-3, 12-8) are "developmental," meaning that data sources for such surveillance need to be developed. As the data systems are created or modified to collect this information for MI patients, parallel efforts should include tracking of 911 use and delay time for all stroke patients and thrombolytic treatment for ischemic stroke patients.
References
1. US Department Health, Human Services. Heart disease and stroke. In: Healthy People 2010: Objectives for Improving Health. Conference edition. Washington, DC: US Public Health Service; 2000.
2. American Heart Association. 2000 Heart and Stroke Facts Statistical Supplement. Dallas, Tex: AHA; 1999.
3. Adams HP Jr, Brott T, Furlan A, Gomez CR, Grotta J, Helgason CM, Kwiatkowski T, Lyden PD, Marler JR, Torner J, Feinberg W, Mayberg M, Thies W. Guidelines for thrombolytic therapy for acute stroke: a supplement to the guidelines for the management of patients with acute ischemic stroke. Stroke. 1996;27:1711–1718.
4.
National Institute
of Neurological Disorders and Stroke rt-PA Stroke Study Group. Tissue
plasminogen activator for acute
ischemic stroke. N Engl
J Med. 1995;333:1581–1587.
5.
Helgason C, Wolf P.
American Heart Association Prevention Conference IV: prevention and
rehabilitation of stroke.
Stroke. 1997;28:1498–1500.
6. Evenson K, Rosamond W, Morris D. Prehospital and in-hospital delays in acute stroke care. Neuroepidemiology.. 2001;20:65–76.[Medline] [Order article via Infotrieve]
7.
Lacy C, Suh D,
Bueno M, Kostis J, for the STROKE Collaborative Study Group. Delay in
presentation and evaluation for acute stroke: Stroke Time
Registry for Outcomes Knowledge and
Epidemiology (STROKE).
Stroke. 2001;32:63–69.
8.
Schroeder E,
Rosamond W, Morris D, Evenson K, Hinn A. Determinants of emergency
medical services use in a population with stroke symptoms: the Second
Delay in Accessing Stroke Healthcare (DASH II) Study.
Stroke. 2000;31:2591–2596.
9. Kothari R, Jauch E, Broderick J, Brott T, Sauerbeck L, Khoury J, Liu T. Acute stroke: delays to presentation and emergency department evaluation. Ann Emerg Med. 1999;33:3–8.[Medline] [Order article via Infotrieve]
10. Rosamond W, Gorton R, Hinn A, Hohenhaus S, Morris D. Rapid response to stroke symptoms: the Delay in Accessing Stroke Healthcare (DASH) Study. Acad Emerg Med. 1998;5:45–51.[Medline] [Order article via Infotrieve]
11.
Menon SC, Pandey
DK, Morganstern LB. Critical factors in determining access to acute
stroke care. Neurol. 1998;51:427–432.
12.
Wester P, Radberg
J, Lundgren B, Peltonen M, for the Seek-Medical-Attention-in-Time Study
Group. Factors associated with delay admission to hospital and
in-hospital delays in acute stroke and TIA.
Stroke. 1999;30:40–48.
13.
Williams L, Bruno
A, Rouch D, Marriott D. Stroke patients’ knowledge of stroke:
influence on time to presentation.
Stroke. 1997;28:912–915.
14. Morris D, Rosamond W, Hinn A, Gorton R. Time delays in accessing stroke care in the emergency department. Acad Emerg Med. 1999;6:218–223.[Medline] [Order article via Infotrieve]
15.
Bratina P,
Greenberg L, Pasteur W, Grotta J. Current emergency department
management of stroke in Houston, Texas.
Stroke. 1995;26:409–414.
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