AcuteCare Telemedicine Blog


Telemedicine Increases tPA Use for Stroke Treatment

Presented at the annual American Academy of Neurology meeting in early May, a new study highlights the benefit of teleneurology care. The report indicates that a telemedicine program for patients with acute ischemic stroke increases the use of recombinant tissue plasminogen activator by as much as 13% in the year after the program’s implementation.

Stroke patients who receive the clot-busting drug tPA within 60 minutes of experiencing stroke symptoms have the best chance of avoiding brain damage or death. The administration of intravenous recombinant tissue-type plasminogen activator (tPA) and intra-arterial approaches, attempt to establish revascularization so that cells in the penumbra can be rescued before irreversible injury occurs, but restoring blood flow can mitigate the effects of ischemia only if performed quickly. “Most of the 13 hospitals in the study significantly increased their recombinant tissue plasminogen activator (tPA) use”, Dr. Jeffrey C. Wagner said at the annual meeting of the American Academy of Neurology.

The study population included patients aged 18 years and older who were admitted with a primary diagnosis of acute ischemic stroke. The hospitals represented a variety of patient demographics. About two-thirds were rural; approximately half were small, defined as fewer than 200 beds. The hospitals were located in the Northeastern, Southern, and Western portions of the United States.

Overall, tPA administration increased significantly, from 4.5% to 7.3% after a telemedicine program was introduced and the use of tPA in smaller hospitals increased from 1% to 7% after implementing a telemedicine program, compared with an increase from 5.4% to 7% in larger hospitals. Those results were similar when patients were stratified as inpatients or transferred patients.

The benefits of intravenous tissue plasminogen activator (tPA) in patients with acute ischemic stroke (AIS) are time dependent and guidelines recommend a door-to-needle (DTN) time of 60 minutes or less. However, studies have found that less than 30% of US patients are treated within this time window. Target: Stroke was designed as a national quality improvement initiative to improve DTN times for tPA administration in patients with AIS. Implementation of a national quality improvement initiative was associated with improved timeliness of tPA administration following AIS on a national scale, and this improvement was associated with lower in-hospital mortality and intracranial hemorrhage, along with an increase in the percentage of patients discharged home.

“Reducing DTN time is a primary goal when treating patients via telemedicine”, says Keith A. Sanders, Founder and Director of the Stroke Center of Emory St. Joseph’s Hospital and AcuteCare Telemedicine (ACT) COO. “ACT has seen dramatic improvements in the tPA administration rate and DTN times at our hospitals. We collect, review and distribute DTN times and other quality measures to our hospital partners. This report reaffirms the importance in administering tPA and its impact on patient outcomes.”



Recognizing the Symptoms of Stroke

While stroke awareness is a major concern for both men and women, a recent study concluded that women are less likely to recognize stroke symptoms. Only half of those surveyed know that sudden weakness or numbness on one side of the face, arms or legs is a warning sign of a stroke. 44 percent are aware that speech difficulty is a stroke sign while less than 1-in-4 could identify sudden severe headache, unexplained dizziness and sudden vision loss, or vision loss in one eye as the top symptoms of stroke. The study surveyed more than 1,200 women in the United States to assess their understanding of stroke’s warning signs.

The signs and symptoms of a stroke vary from person to person but usually begin suddenly. As different parts of the brain control different parts of the body, your symptoms depend upon the part of the brain affected and the extent of the damage.

The main stroke symptoms can be remembered with the word F.A.S.T.: Face-Arms-Speech-Time.

  • Face – the face may have dropped on one side, the person may not be able to smile or their mouth or eye may have drooped
  • Arms – the person with suspected stroke may not be able to lift one or both arms and keep them there because of arm weakness or numbness
  • Speech – speech may be slurred or garbled, or the person may not be able to talk at all despite appearing to be awake
  • Time – it is time to dial 911 immediately if any of these signs or symptoms at the earliest onset of these symptoms

For those living with or who care for somebody in a high-risk group, such as someone who is elderly or has diabetes or high blood pressure, being aware of the symptoms is even more important.

The acronym “FAST” is also meant to underscore the importance of rapidly delivering treatment to stroke patients. If given in time, a clot-busting drug administered during a stroke can lead to better outcomes and a decrease in the likelihood that a patient will suffer long-term disability. A recent study examined the effectiveness of tissue plasminogen activator (tPA) relative to the delay in administering this clot busting drug. Researchers found that every minute tPA was delayed cost nearly 2 days of disability free survival. The researchers commented that their message is literally “Save a Minute, Save a Day.”

Although many Americans live relatively close to a hospital where emergency stroke treatment is available, few actually receive the recommended therapies. Researchers found that only 4 percent of the more than 370,000 Medicare patients who suffered a stroke in 2011 were treated with tPA. Most stroke victims fail to recognize the symptoms of stroke or call 911 early enough to receive the necessary treatment. tPA is most effective when administered within a 4 hour window of time.

Every minute counts for stroke patients. Remember to act F.A.S.T.!



Telestroke: Not Just About tPA

Acute stroke evaluation remains among the most frequently cited benefits of modern telemedicine technology. Known as ‘telestroke,’ the technology allows a neurologist at a remote site to reliably gather data by interviewing patients and family, performing physical examinations and reviewing brain imaging, directly impacting the course of a patient’s care. A recent article from Europe highlights that telestroke offers other benefits, tangible and intangible.

Stroke care in general at a hospital improves in several ways when telestroke consultations become available. Having a system in place to rapidly evaluate and treat stroke patients leads to faster and more accurate treatment of patients who need other brain treatments, such as clot extraction and neurosurgical intervention. Patients with stroke mimics can also be more rapidly treated. Telestroke leads to fewer unnecessary patient transfers, saving valuable time and money.

In stroke, care delayed is care denied. Getting stroke patients the immediate care they need at a local hospital rather than transferring them out leads to better outcomes and happier patients.

As hospital stroke volume increases, the staff gains experience and expertise in treating stroke cases. Stroke order sets provide a checklist to ensure that quality measures are being followed, and with increased experience comes increased use of such standards, which have been shown to improve stroke care. Even obstacles to physician staffing are addressed with telestroke experts on call. Doctors, as much as patients, prefer hospitals providing state of the art care.

In the hospitals we serve, the value of telestroke coverage resonates from the board room to the triage room. This is a technology whose time has come.