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In the United States every 40 seconds someone has a stroke, every 4 minutes someone dies from a stroke and about 400 people die each day from stoke. The faster stroke treatment is provided, the more likely it is to prevent death or a severely disabling outcome. Due to a large rural population, Maine is faced with the challenge of providing appropriate stroke care to all people in a timely, efficient, and effective manner. Modern stroke care has evolved to require advanced imaging and subspecialty care in specialized centers for the largest and most devastating strokes. The longer it takes a patient with a large vessel occlusive stroke (LVO) to get to a hospital in which thrombectomy can be performed, the more likely they are to have completed their stroke, meaning there is little that can be done to greatly improve their stroke outcome. Many patients face delays in transportation due to inadequate emergency medical services resources and Maine does not currently have a statewide system to collect and analyze data to monitor and improve upon the quality of stroke care.
Improving systems of stroke care has been shown to decrease mortality and improve outcomes. Delays in acute stroke care carries substantial public health costs. One study estimated that for every 10 minutes of earlier treatment with mechanical thrombectomy, over $10,000 was saved when incorporating health care and societal perspective into the calculation. The cost of cardiovascular diseases, including stroke, is estimated to substantially increase in the next 15 years. Improved stroke care across the state will add value not only in terms of clinical outcomes but in cost savings across our system.
We recommend having a statewide plan for stroke encompassing the entire chain of care from primary prevention through stroke recovery, by advocating for legislation and funding. Funding should be allocated to upgrade hospitals to meet current standards (e.g., CTA capabilities, telestroke equipment). We need a clear statewide organization for emergency interfacility transportation for stroke patients including written transfer protocols & agreements; we need to employ strategies to improve efficiency of transport to endovascular-capable centers. Data and metrics from all acute care hospitals must be collected and analyzed to effectively deploy resources and education to sites that are not meeting the standards of acute stroke care. Without mandatory data collection and reporting, we will not be able to determine if our interventions to improve our system of stroke care are effective. We should advocate for the creation of State designations for levels of stroke care and to set standards for stroke care, expected services, and quality monitoring.
This is a public health issue, and Maine holds some responsibility in ensuring that all people in the state have access to high-quality stroke care.
Jane G. Morris, MD Maine Medical Center
Allyson Perron Drag, American Heart Association
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