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Improving the Chain of Recovery for Acute Stroke in Your Community: Preamble

December 12-13, 2002


William G. Barsan, M.D.
Steering Committee Co-Chair
University of Michigan Health System, Ann Arbor

On December 12 and 13, 1996, the National Institute of Neurological Disorders and Stroke (NINDS) sponsored a National Symposium on Rapid Identification and Treatment of Acute Stroke*. This initial NINDS symposium followed on the heels of the publication of the NINDS t-PA stroke trial demonstrating the effectiveness of intravenous t-PA for victims of acute stroke when given within 3 hours of stroke onset**. The goal of this conference was to provide a platform for recommending nationwide efforts aimed at implementing rapid therapies for patients with acute stroke, as well as early interventions for many other types of stroke patients. The central theme was that rapid evaluation and treatment would improve the outcome for all stroke patients whether or not they were candidates for thrombolytic therapy.

Six years later to the date, in 2002, the NINDS leadership convened a second symposium entitled "Improving the Chain of Recovery for Acute Stroke in your Community." While there have been demonstrable improvements in the care of patients with acute stroke in many communities, the implementation of acute stroke treatment nationwide has not been easy to accomplish. Across the United States, it is estimated that only about 2 percent of patients with acute stroke are actually receiving acute thrombolytic therapy or related interventional treatments. The majority of patients with acute stroke are still not presenting to the hospital within 3 hours of stroke onset, and while there are effective models for acute stroke treatment teams, most institutions in the United States are still not utilizing these models.

Like the initial 1996 conference, the goal of this second symposium was to prevent death and to improve the overall functional outcome for patients with acute stroke. However, to accomplish this significant public health objective, a primary focus this time was not only to identify barriers to the delivery of rapid acute stroke treatment, but also to provide recommended solutions for overcoming these barriers.

In the months leading up to the symposium, national task forces met and convened to identify areas of concern and focus for recommendations. Six main barriers were chosen for more detailed analysis. These included: public recognition of acute stroke, establishing appropriate levels of care to be provided, professional education, effective templates for stroke triage, incentives for acute stroke care, and support systems for those providing acute stroke care. At the symposium itself, following state of the science didactics, these topics were deliberated and fleshed out using a diverse group of stakeholders. In the end, a set of practical recommendations were formulated and prepared for national dissemination.

We are fortunate that many outstanding and knowledgeable individuals from a variety of professions and medical specialties contributed to this symposium. Our hope is that these task force reports will provide a roadmap for hospitals, health systems, payors, medical professionals, and, of course, the patients we serve. Each year, more than 600,000 Americans suffer from acute stroke and a quarter of these will die. At the same time, more than 3 million Americans are living with some disability resulting from stroke. We hope that the information from these reports will help to alleviate this heavy burden on our society and lead to improved outcomes for all victims of acute stroke.

*Note: Proceedings of a National Symposium on Rapid Identification and Treatment of Acute Stroke. National Institute of Neurological Disorders and Stroke, Bethesda, MD, August 1997, NIH Publication No. 97-4239.

**Note: The NINDS rt-PA Stroke Study Group. Tissue plasminogen activator for acute ischemic stroke. N Engl J Med 1995;26: pp. 843-849.

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National Institute of Neurological Disorders and Stroke
National Institutes of Health
Bethesda, MD 20892

Last Modified April 28, 2011