Top Things to Know: Ideal Foundational Requirements for Stroke Program Development and Growth

Published: February 07, 2023

  1. In the past three decades, American stroke systems have developed and evolved at a rapid pace with four levels of certification of stroke centers: acute stroke ready hospitals (ASRH), primary stroke centers (PSCs), thrombectomy capable stroke centers (TSC) and comprehensive stroke centers (CSCs).
  2. Stroke center certification has dramatically changed the way stroke patients are thought about and cared for, through diagnostic procedures, preventive and treatment strategies.
  3. Stroke center certification standards provides guidance for process elements but lack the guidance for structural components such as workforce, staffing and operations, resulting in in heterogeneous service within hospitals credentialed at the same certification level. This heterogeneity challenges public expectations and transparency about services that are provided.
  4. This statement addresses important gaps in stroke program operations, identifies ideal foundational requirement to assist with design and management with the overall goal of a higher level of effectiveness of stroke centers in the US.
  5. This paper reviews the ideal foundational requirements for stroke centers in the US. Discussion related to stroke center leadership includes corporate leadership, the role the stroke program medical director, the role of advanced practice providers, and the role of the stroke coordinator within the center.
  6. The paper addresses personnel resources such as that of neurointerventionalists, vascular neurologists, telestroke responders, clinical pharmacists, nursing, data collection staff.
  7. Neuroimaging capabilities are a mainstay for diagnostics. The integration of artificial intelligence can augment rapid interpretation and overall stroke team response.
  8. Procedural capabilities such as emergency management of hemorrhagic stroke, determination of stroke mechanism, and transfer resources are also reviewed in this paper and how they interplay with the structural components of a stroke center.
  9. Quality improvement programs are an essential part of stroke program development as well as the conduct of clinical research in stroke centers and especially at CSCs.
  10. Hospital engagement in stroke systems of care and accountability is of critical importance for a successful stroke center.
  11. Certified stroke centers have proven to successfully improve stroke patient outcomes. In addition, stroke center structural standards can reduce variability (striving for standardization across hospitals) in the hospital workforce and in resources that can improve stroke center services.


Dusenbury W, Mathiesen C, Whaley M, Adeoye O, Leslie-Mazwi T, Williams S, Velasco C, Shah S, Gonzales N, Alexandrov AW; on behalf of the American Heart Association Council on Cardiovascular and Stroke Nursing and the Stroke Council. Ideal foundational requirements for stroke program development and growth: a scientific statement from the American Heart Association [published online ahead of print February 7, 2023]. Stroke. doi: 10.1161/STR.0000000000000424