eNeuro

Stroke deaths decline in Oregon, but we’re still too high

Elizabeth Baraban, Ph.D., M.P.H.

Epidemiologist
Providence Brain Institute

Stroke-related mortality has declined across the United States, with stroke falling to the fourth-leading cause of death for the first time in 50 years.

The most recent data published in Circulation, an American Heart Association’s journal, reports that the nation’s annual stroke death rate dropped 44.8 percent between 1997 and 2007.

Oregon’s rate, once the fifth-highest in the country, now ranks No.12.

Reasons for the decrease may be attributed to increased patient access to primary stroke centers, greater awareness of the early signs of stroke symptoms, “Telemedicine is playing a larger role in treating stroke in smaller hospitals and rural locations.” and more patients treated with intravenous tissue plasminogen activator, or IV-tPA, a clot-busting drug that has been shown to increase survival of ischemic stroke and improve functional outcomes.

With most stroke specialists located in larger cities and hospitals throughout the state, telemedicine is playing a larger role in treating stroke in smaller hospitals and rural locations.

Providence began using telemedicine technology in April 2010. With the implementation of telestroke in the smaller hospitals, the IV-tPA treatment rate among all eligible patients with ischemic stroke presenting within the treatment window increased substantially – from 7.1 percent in 2009 to 18.2 percent in 2010. Providence Telestroke Network now employs “remote-presence” video devices in 11 hospitals, giving those emergency departments immediate access to a stroke neurologist.

A study published in JAMA in January 2011 found that patients treated for ischemic stroke at a primary stroke center had a slightly better chance of survival over 30 days than those admitted to nondesignated hospitals. The study also found that the number of patients who received IV-tPA was significantly greater at primary stroke centers.

Nearly 700 hospitals have been certified as primary stroke centers since The Joint Commission began the designation in 2003. Oregon has been on the forefront of acute stroke care with eight primary stroke centers located across the state. Providence Stroke Center was Oregon’s first primary stroke center, established in 2000. Its two largest hospitals – Providence St. Vincent and Providence Portland medical centers – were formally certified in 2003 and 2005.

Despite the gains in Oregon and elsewhere, stroke remains the leading cause of disability among adults. This burden will likely continue to rise given that more people are living with the aftermath of their stroke.

Not surprisingly, the costs of care and rehabilitation for these patients are also on the rise. Some data suggest that the costs associated with stroke and cardiovascular disease surpass those of all other illnesses.

Similar trends are seen in Oregon. Although there have been great improvements in reducing stroke-related mortality, with the increasing cost associated with disability, stroke prevention needs to remain a focus of clinicians and those in public health.

Although stroke deaths continue to fall, Oregon’s rate remains too high. Much more work needs to be done to expand prevention efforts, increase access to primary stroke centers or trained neurologists via telemedicine, and encourage the use of IV-tPA in emergency departments.