Community Intervention Benefits Stroke Patients
Over 700,000 Americans have a ]]>stroke]]> each year. A stroke occurs when the blood flow to the brain is interrupted. Ischemic strokes, which account for 80% of all strokes, are caused by a blood clot that blocks blood flow in the brain.
Because of a lack of oxygen to the brain during a stroke, brain cells immediately begin to die. The effects of a stroke can include paralysis, numbness, imbalance, and difficulty thinking and communicating.
Intravenous (IV) alteplase is the only Food and Drug Administration (FDA)-approved drug to treat a stroke. IV alteplase dissolves blood clots during ischemic strokes. To be effective, it must be given within three hours after a stroke begins. Currently, only 1% to 2% of patients who experience ischemic strokes receive IV alteplase in the U.S.
A study published in the October 13, 2003 issue of the Archives of Internal Medicine tested the effects of an intervention campaign to increase awareness about the benefits of IV alteplase. After the intervention ended, 11% of the patients who had a stroke in the intervention communities received IV alteplase, compared with 2% before the intervention began.
About the Study
The intervention took place in the five hospitals in east Texas over a period of three months. Five other nearby hospitals were chosen as a comparison community.
The intervention targeted community members and medical professionals. The community component of the intervention consisted of radio and television public service announcements, one-on-one training sessions, billboards, brochures, and posters. With these tools, people were urged to respond to a stroke by identifying symptoms, immediately calling 9-1-1, and asking for IV alteplase in the emergency room.
The physician component of the intervention consisted of developing emergency room protocols and conducting continuing medical education classes to increase the use of IV alteplase for the treatment of eligible stroke patients.
The researchers calculated the percentage of eligible stroke patients who were given IV alteplase before the intervention began, and then again during the six months after the intervention ended.
The percentage of ischemic stroke patients who were treated with IV alteplase significantly increased in the intervention community from 2% to 11%, while there was no significant change in the comparison community.
This study was limited in that the hospitals were not randomly assigned to receive the intervention. Instead, the non-profit organization that funded the study, the TLL Temple Foundation, required that the intervention be performed in its community. Also, the intervention took place in a rural environment, so these results may not apply to urban environment settings.
How Does This Affect You?
With just a three-month intervention, the treatment of eligible stroke patients with IV alteplase increased dramatically. This effect continued even after the intervention ended. This study provides the framework for a widespread health promotion campaign to increase the use of IV alteplase after a stroke.
Perhaps even more importantly, these results demonstrate that a public awareness campaign can change the health behaviors of individuals and health care providers. Public health professionals can use this study to support the implementation of other educational campaigns that encourage the rapid identification and treatment of patients with other serious conditions like heart attacks.
The National Institute of Neurological Disorders and Stroke urges people to call 9-1-1 immediately if they experience the following symptoms of a stroke:
- Sudden numbness or weakness in the face, arm, or leg, especially on one side of the body
- Sudden confusion, trouble speaking, or understanding
- Sudden trouble seeing in one or both eyes
- Sudden trouble walking, dizziness, or loss of balance or coordination
- Sudden severe headache with no known cause
In order to be evaluated and treated with IV alteplase within the three-hour window of opportunity, it is best that you arrive at the hospital within 60 minutes after your stroke begins.
National Institute of Neurological Disorders and Stroke
American Stroke Foundation
Know Stroke. Know the signs. Act in time. National Institute of Neurological Disorders and Stroke website. Available at: http://www.ninds.nih.gov/knowstroke?format=printable .
Morgenstern LB, Bartholomew LK, Grotta JC, Staub L, King M, Chan W. Sustained benefit of a community and professional intervention to increase acute stroke therapy. 2003;163:2198-2202.
Last reviewed Oct 16, 2003 by ]]>Richard Glickman-Simon, MD]]>
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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