Multidisciplinary panel releases expert report to improve treatment of acute stroke
The time from notification of the emergency services to treatment with rtPA (`emergency call to needle time`) is critical and can be reduced by coordinating activities between pre-hospital emergency services (paramedic, ambulance) and hospital acute stroke services (emergency departments, stroke units and radiology departments).
The panel emphasises the urgent need to make specialist stroke treatment accessible to the patient at the earliest opportunity after a stroke. They see a need for increased awareness that stroke is a medical emergency and that to save time it is best to call the emergency services and bypass the general practitioner.
"Acute stroke is a medical emergency that requires a rapid coordinated approach between different medical disciplines," said Professor Werner Hacke, Department of Neurology, Rupert-Karls Universität, Heidelberg, Germany and Chairman of the ACT NOW Expert Panel. "We know that rapid treatment of acute stroke, especially in stroke units, definitely improves outcomes and lowers mortality after stroke. Time lost is brain lost and thrombolysis with the thrombolytic rtPA can have a major impact on the clinical outcome of a stroke".
A study analysing the results of more than 2,700 patients in six controlled clinical trials randomised to treatment with either rtPA or placebo was published in the Lancet earlier this year. The study confirmed the benefits of rapid thrombolytic treatment. In addition, it showed that treatment is time dependent, as those patients treated within 90 minutes of symptom onset showed the best recovery and improvement.1
"Quick referral can save lives. It is crucial that all stroke patients are delivered promptly to the hospital best equipped to provide the most appropriate stroke care," said Professor Gary Ford, professor of Pharmacology of Old Age, University of Newcastle, UK. "Patient delivery by the ambulance directly to the stroke unit is ideal. If this is not possible then early warning of the impending arrival of the acute stroke victim from the emergency department, or even better directly from the ambulance service, gives us time to be prepared for immediate action."
Ambulance staff can identify acute stroke patients and can alert specialised hospital staff to the imminent arrival of a suspected stroke victim. "With appropriate training, more and more ambulance staff are able to make emergency stroke assessments themselves," said Mark Cooke, National Clinical Effectiveness Programme Manager, Ambulance Service Association, UK. "They can make a real impact on patient outcome."
The report outlines that emergency departments receiving a patient suffering from suspected acute stroke should conduct an emergency assessment, prior to transferring the patient within minutes to specialised neurological care. "We need written guidelines agreed between the emergency department and a stroke unit to help ensure that all staff are aware of their respective roles," said Professor Luis Garcia-Castrillo Riesgo, Director of the Emergency Medical Department, University Hospital Marques de Valdecilla Cantabria, Spain.
"Hospital nurses are a key link in the chain of rapid specialist patient assessment and management. They can help reduce the impact of the initial event by stabilising the patient, for example prior to and during thrombolysis," said Caroline Watkins, Professor of Stroke and Older People's Care, University of Central Lancashire, North West Stroke Taskforce Coordinator, UK. "They can prevent worsening of the effects of the stroke from secondary brain injury and prevent complications. It has been shown that patients treated in stroke units have reduced mortality and long-term disability compared to those treated in general wards."
Copies of the ACT NOW Expert Report are available from the ACT NOW secretariat and can be downloaded from the EUSI website.
Notes to Editors
ACT NOW Expert Report
The ACT NOW Expert Report, entitled "Improving patient management and outcomes in acute stroke: a coordinated approach", has been developed by a multidisciplinary panel of experts with a keen interest in the management of stroke. The report aims to communicate and cascade best practice internationally and nationally within the constraints of national health care systems. The report shares best practice in acute stroke management within emergency medical services and relevant hospital departments and gives examples of pathways to optimise coordination between disciplines. The ACT NOW Expert Report will be distributed in all European countries to promote best practice and builds on guidelines recently issued by the European Stroke Initiative (EUSI).
Stroke
Stroke is one of the leading causes of morbidity and mortality and is the leading cause of disability in the developed world.2 The WHO estimates that 5.1 million people die from stroke each year.3
In Europe, stroke accounts for 1.3 million deaths each year. In the US, an estimated 700,000 to 750,000 new and recurrent strokes occur each year. 15 million people worldwide each year survive minor strokes and 600 million people with high blood pressure are at risk of heart attack, stroke and cardiac failure. Almost one in four men and one in five women aged 45 years can expect to have a stroke if they live to their 85th year.
Related links:
Website of EUSI (download of the ACT NOW Expert Report)
Contact:
ACT NOW
Secretariat
Ute Schmidt
Phone: +44 207 309 1113
Fax: +44 207 309 1221
Boehringer Ingelheim GmbH
Corporate Division Communications
Julia Meyer-Kleinmann
Binger Strasse 173
55216 Ingelheim am Rhein
GERMANY
Phone: +49/6132/77 82 71
Fax: +49/6132/77 66 01
References:
1 Hacke W et al. Association of outcome with early stroke treatment: pooled analysis of ATLANTIS, ECASS, and NINDS rt-PA stroke trials. Lancet. 2004 Mar 6;363(9411):768-74
2 Albers GW, Clark WM, Wissman S, et al. Recombinant Tissue-type Plasminogen Activator (alteplase) for ischaemic stroke 3 to 5 hours after symptom onset. JAMA 1999:282;2019-2026.
3 European stroke initiative recommendations for stroke management. Update 2003. Cerebrovasc Dis 2003, 16:311-337.
Multidisciplinara a lansat panoul de raport de expertizã pentru a îmbunãtãþi tratamentul de accident vascular cerebral acut - Multidisciplinary panel releases expert report to improve treatment of acute stroke - articole medicale engleza - startsanatate