Acute stroke therapy used 3 times more at certified primary stroke centers

(Press-News.org) PHILADELPHIA - Certified Primary Stroke Centers are three times more likely to administer clot-busting treatment for strokes than non-certified centers, reports a new study by researchers in the Perelman School of Medicine at the University of Pennsylvania. The study, published in the Journal of the American Heart Association, looked at a wide sample of hospitals across the United States, and provides insight into practice across the US health care system as experts examine ways to increase the use of this important therapy.

Clot busting treatment is used to open blocked blood vessels, restoring blood flow to the brain and reducing disability after stroke. Less than half of ischemic stroke patients who are eligible for the treatment, recombinant tissue plasminogen activator (rt-PA), actually receive it. Currently, only a small percentage of stroke patients receive rt-PA therapy.

"We found that primary stroke centers administered rt-PA at a much higher rate than other hospitals, demonstrating one way that certified centers are succeeding." said Michael T. Mullen, MD, the study's lead author and an assistant professor of Neurology at the Perelman School of Medicine at the University of Pennsylvania.

Primary Stroke Centers, certified through The Joint Commission, used rt-PA in 6.7 percent of cases, whereas non-certified centers used the drug 2.2 percent of the time. The study also found that, between 2004 and 2009, the annual percentage of rt-PA administration increased from 1.4 percent to 3.3 percent at non-PSCs and 6.0 percent to 7.6 percent at PSCs.

National goals aim to reduce stroke mortality by 20 percent and increase appropriate use of thrombolytic therapy for acute stroke, as part of Healthy People 2020, a report of the US Department of Health and Human Services which highlights the nation's 10 year goals for health promotion and disease prevention. "Although it is encouraging to see higher treatment rates at primary stroke centers, we are still not getting this important therapy to enough stroke patients. People need to know the signs of a stroke, know to call 911, and quickly get to a hospital that is prepared to treat them," said Dr. Mullen.

"Given the impact of the primary stroke center model in the use of rt-PA, we need to measure and expand access to stroke care in the US," said the study's senior author Brendan Carr, MD, MA, Assistant Professor of Emergency Medicine, Surgery, & Epidemiology in the Perelman School of Medicine at the University of Pennsylvania. "For serious unplanned events like stroke, the goal is to make sure that all Americans have the ability to promptly reach optimal care." Patients, providers, and planners can find out about population access to stroke care at http://www.strokemaps.org.

### Penn Medicine has received certification for stroke care at all member hospitals: the Hospital of the University of Pennsylvania is the first and only hospital in Philadelphia to receive The Joint Commission's advanced Comprehensive Stroke Center certification; Pennsylvania Hospital and Penn Presbyterian Medical Center received Primary Stroke Center certifications from The Joint Commission in the summer of 2012. In addition, the telemedicine component of the Penn Neuro Rescue program provides Penn's comprehensive neurovascular expertise to affiliated hospitals throughout the region through live, remote consults, enabling the Penn neurological emergency team to diagnose and treat strokes 24/7 in affiliated hospitals.

Additional co-authors include Scott Kasner, MD, and Michael Kallan, MS, MPH from Penn Medicine, Dawn Kleindorfer, MD, from the University of Cincinnati and Karen Albright, DO, from the University of Alabama at Birmingham. The Agency for Health Care Research and Quality and the National Institutes of Health (HL083772) funded this research.

Penn Medicine is one of the world's leading academic medical centers, dedicated to the related missions of medical education, biomedical research, and excellence in patient care. Penn Medicine consists of the Raymond and Ruth Perelman School of Medicine at the University of Pennsylvania (founded in 1765 as the nation's first medical school) and the University of Pennsylvania Health System, which together form a $4.3 billion enterprise.

The Perelman School of Medicine has been ranked among the top five medical schools in the United States for the past 16 years, according to U.S. News & World Report's survey of research-oriented medical schools. The School is consistently among the nation's top recipients of funding from the National Institutes of Health, with $398 million awarded in the 2012 fiscal year.

The University of Pennsylvania Health System's patient care facilities include: The Hospital of the University of Pennsylvania -- recognized as one of the nation's top "Honor Roll" hospitals by U.S. News & World Report; Penn Presbyterian Medical Center; and Pennsylvania Hospital — the nation's first hospital, founded in 1751. Penn Medicine also includes additional patient care facilities and services throughout the Philadelphia region.

Penn Medicine is committed to improving lives and health through a variety of community-based programs and activities. In fiscal year 2012, Penn Medicine provided $827 million to benefit our community.