One-third of the US population does not have access to a primary stroke centre within one hour by ambulance, and even under optimal conditions, a large proportion of the population would be unable to access a stroke centre within this window, according to a new study published in Neurology.
“Research has shown that specialised stroke care has the potential to reduce death and disability,” said study author Michael T Mullen, with the Perelman School of Medicine at the University of Pennsylvania, USA and a member of the American Academy of Neurology. “Stroke is a time-critical disease. Each second after a stroke begins, brain cells die, so it is critically important that specialised stroke care be rapidly accessible to the population.”
The study examined data from 2010, when there were 811 primary stroke centres and no comprehensive stroke centres in the USA. Mullen and his colleagues created models to estimate what proportion of the population would have access to a comprehensive stroke centre within an hour under optimal circumstances.
The study found that converting up to 20 optimally located primary stroke centres per state into comprehensive stroke centres would result in 63% of the population living within a one-hour drive and an additional 23% within a one-hour flight of a centre. There was however substantial variability in access, with some states lagging behind the national average.
“Even under optimal conditions, many people may not have rapid access to comprehensive stroke centres, and without oversight and population level planning, actual systems of care are likely to be substantially worse than these optimised models,” said Mullen. He also noted that access to care in the models was lowest in the south eastern USA, an area often referred to as the “Stroke Belt.”
“There are geographic differences in stroke incidence, especially in rural areas and in the Stroke Belt,” Mullen said. “Reduced access to specialised stroke care in these areas has the potential to worsen these disparities. This emphasises the need for oversight of developing systems of care.”
Mullen said he is hopeful that optimisation modelling studies, such as this one, could help policy makers and health planners identify areas of need, with the ultimate goal of ensuring that specialised stroke care is accessible throughout the USA.
The study was supported by the Agency for Healthcare Research & Quality.