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(Stroke. 2005;36:1358.)
© 2005 American Heart Association, Inc.

Letters to the Editor

Organizing Stroke Systems of Care

Marilyn M. Rymer, MD

Mid America Brain and Stroke Institute, Saint Luke’s Hospital, Kansas City, Mo

An extract of the first 250 words of the full text is provided, because this article has no abstract.

To the Editor:

I read with great interest the American Stroke Association (ASA) policy recommendation entitled Recommendations for the Establishment of Stroke Systems of Care.¹ It is encouraging to see that this task force validates the recommendations from the 2 symposia sponsored by the National Institute of Neurological Disorders and Stroke held in 1997 and 2002.^2,3 There appears to be consensus on what systems need to be in place to optimally prevent and treat stroke. The challenge lies in effective implementation. Approximately 9 years after the Food and Drug Administration approved intravenous tissue plasminogen activator (IV tPA), the number of patients treated annually has not increased. It appears that simply agreeing on what should happen does not make it so.

The ASA’s Task Force set forth 5 general recommendations for stroke systems,¹ but there is no clear description of who or what is organizing this comprehensive "systems" approach. The NINDS task force also emphasized the "need to link and coordinate the activities of providers, concluding that a stroke system should fundamentally be a single entity that is responsible for organizing the stroke system"³ without helping us understand who that "single entity" is. It is possible that we could fast-forward 9 more years and not have gained much ground.

As with all complex tasks, there is likely to be more than one successful approach. The "top down single entity" model is going to require state and/or federal leadership and support. Florida and New York appear to be headed in this direction. . . . [Full Text of this Article]

Lee H. Schwamm, MD, FAHA

Harvard Medical School and MIT Clinical Research Center, Department of Neurology, Massachusetts General Hospital, Boston, Mass

Joe Acker, EMT-P, MPH, MS

Birmingham Regional E, Birmingham, Ala

Arthur Pancioli, MD

Department of Emergency Medicine, University of Cincinnati, College of Medicine, Cincinnati, Ohio