Abstract 3594: A Pilot Feasibility Study of Community Engaged Stroke Preparedness: The ASPIRE Project
BACKGROUND: Lack of culturally appropriate education about stroke may prevent people from recognizing symptoms and/or seeking immediate care. The Stroke Warning Information and Faster Treatment (SWIFT) intervention reports increasing the proportion of prevalent stroke/TIA cases arriving under 4.5 hours using culturally tailored strategies, but few interventions have rigorously evaluated preparedness strategies in community settings. ASPIRE is a multi-dimensional program with a three-pronged approach (community, hospital, EMS) to acute stroke preparedness targeted to increased IV tPA utilization in underserved black communities in the DC metro area.
METHODS: Using community engaged methodology, a skill-based approach to teaching community members to recognize acute stroke, call 911 and navigate the ER setting was developed. In the pilot phase, 50 education sessions were conducted in church, civic, educational and work organizations over a six month period in Ward 7 of the DC Metro area. Local ER and EMS staff were also in-serviced. We prospectively identified all hospital stroke admissions and EMS utilization information including acute stroke parameters for the 6 month pre and post intervention periods. Pre-post pilot intervention acute ischemic stroke parameters were compared.
RESULTS: In the pre-intervention period, we identified 142 ischemic strokes in Ward 7: mean age 63 yrs; 63% male; 96% blacks. Fifty-six percent arrived via EMS, with a mean and median time to arrival of 1600 minutes (27.0 hours), and 890 minutes (14.8 hours), respectively. Following the intervention we identified 115 ischemic stroke cases: 66 yrs; 47% male; 89% black. Fifty percent arrived via EMS, mean and median time to arrival was 1423 min (23.7 hours) and 815 min (13.6 hours). In addition to this modest decrease in overall arrival times, an increased proportion of cases arriving in the 4.5 hours group was noted [pre 25% vs. post 28%, p=NS]. We were also able to match 104 ischemic stroke cases to EMS utilization sheets demonstrating feasibility for larger evaluation.
CONCULSION: The ASPIRE pilot demonstrates feasibility of the multilevel community education intervention as well as feasibility of linking EMS and hospital records on a city wide scale. Despite the small number of ischemic strokes in this pilot phase, a modest reduction in hospital arrival times occurred in the post intervention phase. A city-wide intervention aimed at increasing the proportion of stroke patients treated with IV tPA is currently underway.
- © 2012 by American Heart Association, Inc.