From the Departments of Medicine (Neurology) (L.B.G.) and Surgery
(L.A.H., R.L.), Duke Center for Cerebrovascular Disease (L.B.G.), Center for
Clinical Health Policy Research (L.B.G.), Center for Clinical Effectiveness
(L.A.H., R.L.), Duke University, Durham, NC, and the Durham VA Medical Center
(L.B.G.), Durham, NC.
Correspondence to Larry B. Goldstein, MD, Director, Duke Center for Cerebrovascular Disease, and Head, Stroke Policy Program, Center for Clinical Health Policy Research, Box 3651, Duke University Medical Center, Durham, NC 27710. E-mail golds004{at}mc.duke.edu
Background and Purpose—North
Carolina is situated in the "stroke belt" region of the United
States, an area of the country with a particularly high incidence of
cerebrovascular disease. The North Carolina Stroke Prevention and
Treatment Facilities Survey was carried out to determine the
availabilities of a variety of stroke prevention and treatment services
throughout the state. The purpose of the present study was to
determine how widely recombinant tissue-type plasminogen
activator (rtPA) has been adopted for the treatment of
patients with acute ischemic stroke and to determine the
characteristics of the medical facilities in the state offering
this therapy.
Methods—A single-page survey was mailed to the medical center
directors of each inpatient medical facility in North Carolina. Data
collected included questions related to the availability of selected
basic and advanced diagnostic tests and procedures, stroke
prevention and treatment programs and services (community stroke
awareness program, acute stroke identification program, acute stroke
team, stroke rtPA protocol, stroke care map, neurologist), and
facilities (Stroke Acute Care Unit or equivalent).
Results—Responses were obtained from all 125 inpatient medical
facilities in North Carolina. rtPA stroke protocols were adopted in 54
facilities located in 46 of the state's 100 counties. Seventy-four
percent of the state's population resides in counties with hospitals
providing rtPA treatment. Compared with facilities not offering rtPA,
those with rtPA protocols more commonly sponsored stroke community
awareness programs (41% versus 17%, P=0.003) and more
frequently had an organized stroke team (31% versus 8%,
P=0.001), used stroke care maps (56% versus 17%,
P<0.001), had rapid stroke identification programs
(33% versus 6%, P<0.001), or had a Stroke Acute Care
Unit or its equivalent (33% versus 7%, P<0.001).
Neurologists were available in 78% of the facilities offering rtPA
compared with 38% in facilities without rtPA protocols
(P<0.001).
Conclusions—These data show that this new therapy for
ischemic stroke is potentially available to a high proportion
of the state's citizens based on their county of residence. However,
other services that may improve outcomes and reduce stroke-related
costs (eg, stroke teams, stroke units, care maps) are not being widely
used, even in centers providing treatment with rtPA. The simple
methodology used in this study is potentially applicable in other
states and permits targeting of selected centers for development of
stroke treatment capabilities.
© 1998 American Heart Association, Inc.
Original Contributions
North Carolina Stroke Prevention and Treatment Facilities Survey
rtPA Therapy for Acute Stroke
Key Words: cerebrovascular disorders • data collection • emergency medical services • plasminogen activator, tissue type • thrombolytic therapy
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