AcuteCare Telemedicine Blog

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.

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