Top Things to Know: Identifying Best Practices for Improving the Acute Evaluation and Management of Stroke in Rural and Lower Resourced Settings
Published: December 12, 2024
Prepared by Anne Leonard MPH, RN AHA National Senior Director Science and Medicine
- The majority (61%) of US emergency departments (EDs) are in hospitals without any level of stroke center or acute stroke ready hospital (ASRH) certification, with over 28 million people in the US living more than 60 miles from a stroke center of Acute Stroke Ready Hospital (ASRH) certification.
- This is particularly pronounced in rural settings; of the 1109 rural EDs open in 2019, only 206 (19%) were in a hospital with stroke center or ASRH status, and urban centers have 13-fold greater odds of becoming a primary stroke center (PSC) versus rural hospitals.
- Patients with stroke in rural hospitals have higher mortality rates than those in urban hospitals.
- There are significant variations in resources between EDs and variations in access to stroke-related resources for patients, necessitating strategies to improve care and reduce variability across broad and diverse geographical regions.
- Structural constraints of the US healthcare system, including the geographic distribution of where patients live relative to the location of hospitals and certified stroke centers, results in many patients with stroke arriving at uncertified community EDs lacking major quality improvement (QI) efforts and interventions.
- This statement discusses the challenges of developing coordinated stroke systems of care in remote/rural settings and offers considerations to mitigate these challenges.
- Coordinated regional care systems are critical in optimizing patient outcomes in all care settings and especially in remote or rural settings.
- Challenges in care are described in several areas related to urgent/emergent stroke care: prehospital setting, thrombolysis and emergency department care, transfer of patients to higher level of care, thrombectomy access, inpatient care, and post-acute care transitions of care (from hospital to home).
- This statement discusses the expansion of acute stroke ready hospitals (ASRH) and primary stroke center certification (PSC) and the use of advanced practice providers (APPs) in remote or rural areas.
- In rural or under resourced settings, disparities in stroke care pose unique challenges and will impact many patients. Strategic interventions and investments are needed to support the entire spectrum of prehospital, acute and post-acute care for the emergency medical services, emergency departments, and hospitals that are the pivot points within the stroke system of care system.
Citation
Zachrison KS, Asif KS, Chapman S, Leira EC, Joynt Maddox KE, Maynard S, Nobleza COS, Wira CR; on behalf of the American Heart Association Emergency Neurovascular Care and Telestroke Committee of the Stroke Council; Council on Cardiovascular and Stroke Nursing; and Council on Cardiovascular Radiology and Intervention. Identifying bestpractices for improving the evaluation and management of stroke in rural lower-resourced settings: a scientificstatement from the American Heart Association. Stroke. Published online December 12, 2024. doi: 10.1161/STR.0000000000000478