Optimizing Stroke Treatment: Key Interventions to Reduce Delays

Highlights from the statement:

An in-hospital stroke is a stroke that occurs during a hospitalization for another diagnosis.
In-hospital stroke affects approximately 35,000 to 75,000 hospitalized people annually in the United States and occurs most frequently among patients who have undergone a recent procedure or invasive diagnostic test.
The statement details five key suggestions focused on reducing delays and optimizing treatment to improve outcomes for these patients.

Although hospitalized patients are in a monitored setting, stroke evaluation and treatment are often delayed compared to patients arriving with stroke to the emergency department, contributing to higher rates of morbidity and mortality. for stroke in the hospital, according to an American Heart Association scientific statement published online in the Association’s Stroke journal.

A scientific statement from the American Heart Association is an expert analysis of current research and can inform future clinical practice guidelines.

The statement outlines five elements for developing hospital systems of care and quality improvement aimed at reducing delays and optimizing treatment to improve outcomes for patients who experience stroke in the hospital.

In-hospital stroke is a stroke that occurs during a hospitalization for another diagnosis and affects 35,000 to 75,000 hospitalized patients annually in the United States.

The five central elements of the declaration are:

Train all hospital staff on signs and symptoms of stroke and protocols for activating in-hospital stroke alerts.
Create rapid response teams with specialized stroke training and immediate access to neurological expertise.
Standardize the evaluation of potential stroke patients in the hospital with physical assessment and imaging.
Eliminate and address potential treatment barriers, including transfer between centers for advanced stroke treatment.
Establish a hospital-based stroke quality monitoring program that provides data-driven performance feedback and drives targeted quality improvement efforts.

The statement encourages institutions to develop a plan for inpatient stroke response teams that includes education, quality review, and targeted oversight.

The statement was developed by the writing committee on behalf of the Stroke Council of the American Heart Association; the Council on Atherosclerosis, Thrombosis and Vascular Biology; the Cardiovascular Nursing and Stroke Council; the Council of Clinical Cardiology; and the Council on Lifestyle and Cardiometabolic Health.

The diverse committee included experts in nursing, neurology, internal medicine, neurocritical care, neurosurgery, and neurointerventional radiology. The American Academy of Neurology affirms the value of this statement as an educational tool for neurologists, and the American Association of Neurological Surgeons/Congress of Neurological Surgeons, Cerebrovascular Section affirms the educational benefit of this statement.

The American Heart Association’s scientific statements promote greater awareness of cardiovascular disease and stroke and help facilitate informed health care decisions.

Scientific statements describe what is currently known about a topic and what areas need additional research. While scientific statements inform guideline development, they do not make treatment recommendations. The American Heart Association guidelines provide the Association’s official clinical practice recommendations.

The writing committee includes President Ethan U. Cumbler, MD; Vice President Amre Nouh, MD, FAHA; Sepideh Amin-Hanjani, MD, FAHA; Karen L. Furie, MD, MPH, FAHA; Walter N. Kernan, MD; DaiWai M. Olson, Ph.D., RN; Fernando D. Testai, M.D., Ph.D., FAHA; Mark J. Alberts, MD, FAHA; and Mohammed A. Hussain, MD Author disclosures are listed in the manuscript.

Optimizing Stroke Treatment: Key Interventions to Reduce Delays

Five key interventions are identified to optimize stroke treatment, focusing on reducing treatment delays and improving access to timely reperfusion therapies to maximize functional outcomes and minimize disability in stroke patients.