AcuteCare Telemedicine Blog


Obstructive Sleep Apnea and Atherosclerosis

Atherosclerosis is the leading cause of stroke and cardiovascular disease, the leading causes of death internationally, but recently, obstructive sleep apnea (OSA) has also been found to be an independent risk factor for stroke. One explanation may lie in the propensity towards the development of atherosclerosis in this disorder. Identifying this and other potential risk factors of atherosclerosis and understanding how these risk factors behave independently and comorbidly will hopefully reduce the risk of atherosclerotic disease, ultimately aiding in the prevention of stroke.

OSA is a lesser known independent risk factor for stroke than hypertension (HTN), but both are frequently observed as comorbidities in patients with cardiovascular disease and stroke. In 2009, a study published in Hypertension found that patients with OSA and patients with HTN had an increase in carotid wall thickness compared to controls by 19.4% and 19.5% respectively. In patients with OSA and HTN, the increase was found to be 40.3% in carotid wall thickness over controls. These and other findings strongly suggest that OSA is indeed an independent risk factor for the development of carotid atherosclerosis.

OSA has been shown to independently increase several markers of atherosclerosis including sympathetic activity, pro inflammatory factors and endothelial dysfunction. In addition, OSA can lead to other atherosclerotic risk factors such as alteration in lipid metabolism, insulin resistance and hypertension.  In 2007, a separate study published in the American Journal of Respiratory and Critical Care Medicine involved twenty-four patients with OSA and without comorbidities. After 4 months of treatment with continuous positive airway pressure, there was a reduction in markers of inflammation and sympathetic activation as well as a decrease of carotid wall thickness; again evidence to suggest OSA as a risk factor for atherosclerosis.

The importance of these studies and others suggesting OSA as an independent risk factor for atherosclerosis is to arm physicians with more ways to combat the incidence of stroke and cardiovascular disease. Because of the high incidence of OSA in patients with HTN, control of HTN alone may not adequately reduce atherosclerotic risk. Screening tools such as the STOP/BANG and Berlin questionnaire should be utilized in  hypertensive patients, particularly those with refractory disease (>3 BP meds with adequate control or 3 BP meds with inadequate control). Overnight polysomnography should be performed in patients identified at risk for OSA and treatment should be initiated when appropriate. Likewise, in patients without known atherosclerotic risk factors but suspected OSA, screening and diagnostic studies should be performed. These measures can help to further reduce the incidence of atherosclerosis and subsequently reduce the incidence of cardiovascular disease and stroke.



AcuteCare Telemedicine Thrives in 2011, Poised for Continued Growth in 2012

AcuteCare Telemedicine (ACT), an Atlanta-based leader in telemedicine services, approaches the end of 2011 having made significant strides during the year. Overall, the business saw more than 300% growth, with its telemedicine model proving to be an effective solution for client hospitals. The partners of ACT now provide 24/7 expert emergency neurological emergency care to numerous facilities throughout the southeast, while significantly impacting the bottom line of contracted hospitals.

In November, ACT added a new Sales Executive, Michael Woodcock, to acquire new accounts while maintaining the company’s existing client base.  Woodcock is able to focus on executing the business’ growth strategy as it moves forward into 2012. In addition, a newly formed Board of Advisors will be announced in January 2012 to support extending the company’s geographic reach and influence as leaders in the industry.

“ACT has brought an unparalleled level of expertise in emergency teleneurology care to patients throughout Georgia and the Southeast,” says Woodcock. “We feel confident that this expertise, combined with sound growth strategies, will allow us to achieve our sales objectives in 2012 and beyond.”

The partners of ACT are enthusiastic about the company’s progress in 2011. “This was a phenomenal year of growth; the doubling of our hospital contracts, our midyear engagement of Junction Creative Solutions (an Atlanta-based strategic firm) to hone our business plan, and establishing a full-time sales team were all great strides,” comments Dr. Keith Sanders, COO, ACT. Dr. Matthews Gwynn adds “The addition of new hospitals to our list of clients in 2011 has meant that more clients recognize the real value of ACT.”

“Our expansion has given us an opportunity to deliver state of the art acute stroke care to patients who previously would not have had access to it,” says Dr, Lisa Johnston. “We look forward to continuing to provide cost efficient, high quality patient care, particularly to those in underserved regions.”

“ACT has maintained a laser focus on its mission,” says Dr. James Kiely. “The growth we have experienced is a testament to the fact that ACT delivers on its promise. We are just getting warmed up.”



What Stroke and Heart Attack Have In Common

Because brains and hearts are highly dependent on oxygen-rich blood to survive, current guidelines from the American Heart Association call for treatment in under an hour for both strokes and heart attacks. The phrase “Door-to-treatment” refers to the time it takes from a patient’s emergency room arrival to the initiation of treatment.

In heart attacks, “door-to-balloon” more specifically refers to the use of an angioplasty balloon to relieve a constricted or obstructed blood vessel. In cases of stroke, the key phrase is, “door-to-needle,” referring to the administration of the intravenous medication tPA. The two different organs, with different vascular beds and dealt with by different teams of specialists within a hospital, remain subject to very similar constraints in time and quality measures.

The care of these patients requires a team approach with emergency room nurses and doctors rapidly initiating the process. At all hours, parallel specialized teams must stand ready to reverse critical brain and heart ischemia. Telemedicine technologies have proven to be an efficient solution in allowing very rapid access to quality care.

As leaders in the fight against the morbidity and mortality of these emergencies, AcuteCare Telemedicine (ACT) leads the stroke team at several hospitals, ensuring that proper treatment is available to patients within the critical hour. In addition, ACT monitors stroke care and provides important feedback to the hospitals it serves, because constant evaluation of the timeliness and quality of treatment is a crucial component in reducing the “door to needle” time to help save lives.



AcuteCare Telemedicine Announces Partnership with Taylor Regional Hospital

AcuteCare Telemedicine (ACT) announces a new partnership with Taylor Regional Hospital, a private, not-for-profit facility with 55 beds in Hawkinsville, GA.  Taylor Regional Hospital now has access to telemedicine technologies that will provide personal neurology consultation to the patients at the rural facility, in addition to increasing hospital revenues and the quality of acute neurological emergency care available to patients.

In the first month at Taylor Regional, ACT treated at least two patients with stroke in the emergency department. One patient received tissue plasminogen activator (tPA), the potentially life-saving drug used to open up thrombosed arteries in stroke. Prior to ACT’s involvement at Taylor Regional, patients had to be redirected to facilities in Macon, GA or Atlanta, GA to receive these time-sensitive treatments.

Lynn Grant, RN ER & Trauma Team Manager and Stroke Champion at Taylor Regional is pleased about having the neurologists of ACT available for consultation at a moment’s notice. “This is a wonderful opportunity for our community and hospital to be able to provide this service,” says Grant.

The partners of ACT hope that the partnership can be a model for increasing patient access to top quality neurology care in remote areas in Georgia and throughout the “stroke belt” states of the Southeast. “Taylor Regional Hospital is the quintessential ‘diamond in the rough.’ They have a population in need and the facilities to care for them,” comments Dr. James Kiely, Ph.D, CIO, ACT. “They simply lacked the neurological expertise which ACT can now provide.”

ACT plans to continue extending its reach into hospitals and medical facilities in underserved areas to combat the morbidity and mortality of stroke. To learn more, go to www.acutecaretelemed.com.



Stroke Care Requires a Change in Behavior

More than 2 million brain cells die each minute during a stroke. Reducing the time from a patient’s arrival in the emergency room to the administration of the clot-busting agent tPA, the so-called “door to needle” time, is paramount. A major obstacle to treatment outside the direct influence of the physician is when individuals with stroke symptoms delay seeking treatment.

The public is not without knowledge of stroke. Multiple websites and sources help people recognize stroke symptoms. These include academic sites such as the Mayo Clinic, commercial sites like WebMD, and government resources from the NINDS (National Institute of Neurological Disorders and Stroke). Public service announcements have been used to improve the awareness of stroke symptoms. More importantly, the time sensitive nature of stroke treatment has been brought to the forefront as a focus since the 1990’s. Education does help; the percent of patients arriving to the ER within 24 hours of stroke onset nearly doubled following a 1992 campaign stressing the need for early treatment.

However, in 1996, following FDA approval of tPA use with a 3 hour time limit, the role of timeliness in stroke treatment became even more crucial. Whereas public awareness of stroke symptoms had improved, education campaigns had not sufficiently decreased the time to respond. Even today, many patients are still missing the benefits of immediate treatment with tPA. Education has achieved its goal, making the risks of stroke and the availability of treatment understood, but changing behavior is not as easy. The public is not unafraid of stroke; people may simply be too afraid of the diagnosis. Delays result from the inability to accept that a stroke is actually occurring. Furthermore, previous unfavorable experiences in receiving care or suboptimal outcomes can influence future behavior.

This concept is supported by data in patients with myocardial infarctions (heart attack) which suggest psychological factors may be at play. The extrapolation of this behavior to stroke is not difficult given the typical presentation of stroke is not painful and often not immediately disabling. Society must reinforce the immediate use of the 911 system and healthcare providers must endeavor to give every stroke event the best possible outcome. Otherwise, patients who “wait and see” if it is really going to become a problem suffer as brain cells die.