A recent study in Neurology has the potential to have profound implications for reducing the global burden of stroke.
The article, Integrated systems of stroke care and reduction in 30-day mortality, was published in the official journal of the American Academy of Neurology in February. The study evaluated the association between the presence of integrated systems of stroke care and stroke case-fatality across Canada.
“This study is important because it provides additional evidence that coordinated regional systems of stroke care, of which the Ontario Stroke Network is an excellent example, may reduce mortality from stroke,” said one of the study’s authors Moira K. Kapral, MD, MSc, FRCPC. “If a similar benefit is seen as integrated stroke systems are implemented in other jurisdictions, this could have a global impact on stroke mortality.”
The research looks at outcomes of mortality across provinces in Canada, comparing provinces with integrated stroke strategies to provinces without over the study period. A total of 319,972 patients were hospitalized for stroke/TIA. The crude 30-day mortality rate decreased from 15.8% in 2003/2004 to 12.7% in 2012/2013 in provinces with stroke systems, while remaining 14.5% in provinces without such systems. Starting with the fiscal year 2009/2010, there was a clear reduction in relative mortality in provinces with stroke systems vs those without. The research also indicated that facilities in provinces with such systems were more likely to care for patients on a stroke unit, and have timely access to a stroke prevention clinic and Telestroke services.
The authors have highlighted an opportunity that may have profound implications for reducing the global burden of stroke: implementation of centralized systems of stroke care with high-level government oversight. Kapral said future work could focus on identifying the specific components of stroke systems that are most likely to account for improvements in outcomes and on determining whether integrated systems of stroke care are as effective in other countries with different systems of health care organization and delivery.
Ontario Stroke Network Evaluation Lead and Institute for Clinical Evaluative Sciences adjunct scientist Ruth Hall said that Ontario was the first province to establish an integrated approach to stroke care. “Since 2003/04, the 30-day mortality has decreased from 16 per cent to 12 per cent in 2013/14,” she said. “During the past 10 years, the percentage of Ontario stroke patients receiving care at designated stroke centres where there is the infrastructure, treatments, stroke expertise and integrated care planning needed to improve patient outcomes, has increased from 41 per cent to 57 cent.”
Hall said these changes have resulted in:
- more patients receiving diagnostic imaging, from 67 per cent to 93 per cent;
- a tripling in the percentage of patients getting access to the clot-busting intervention tPA from four per cent to 12 per cent; and
- more patients accessing inpatient rehabilitation, from 28 per cent to 34 per cent
Additionally, since 2003/04, there has been a ten-fold increase in access to stroke physician expertise and key stroke interventions like thrombolysis, through videoconferencing – Telestroke, from two to 23 sites in 2013/14.
Aravind Ganesh, MD, Patrice Lindsay, RN, PhD, Jiming Fang, PhD, Moira K. Kapral, MD, MSc, FRCPC, Robert Côté, MD, Ian Joiner, Antoine M. Hakim, MD, PhD and Michael D. Hill, MD, MSc, FRCPC.
About the Ontario Stroke Network:
The Ontario Stroke Network (OSN, www.ontariostrokenetwork.ca), created in 2008, is a non‐profit organization funded by the Ministry of Health and Long‐Term Care. The OSN provides provincial leadership and planning for the continuum of stroke care in Ontario—from health promotion and stroke prevention to acute care, recovery, rehabilitation and reintegration. OSN is committed to creating innovations in stroke prevention and care and regularly evaluates the stroke system, partners to achieve best practices, and promotes excellent stroke care and vascular health while advocating for fewer strokes and better outcomes.
For more information:
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Ontario Stroke Network
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firstname.lastname@example.org | www.ontariostrokenetwork.ca
Cell: (416) 455-7394