Far too many of the nearly 795,000 people in the United States who suffer a stroke each year receive inadequate care. In 2001 the Centers for Disease Control and Prevention (CDC) received funding from Congress to set up the Paul Coverdell National Acute Stroke Registry, named for the Georgia senator who died from a stroke. A recent report summarizes the status of care from 2005 through 2007 in four of the participating states: Georgia, Illinois, Massachusetts, and North Carolina. Data on 56,969 patients were contributed by 195 hospitals.

Men and women were equally affected by stroke in the four states, although other patient characteristics varied. For instance, stroke incidence among blacks was 5.6% in Massachusetts and 35.8% in Georgia, and the median age of stroke patients was highest in Massachusetts (77 years) and lowest in Georgia (67 years). The most common risk factors include hypertension, hyperlipidemia, diabetes, cigarette smoking, and previous history of stroke, heart attack, and transient ischemic attack. Compared with stroke care between 2001 and 2004, significant improvement has been seen in screening patients for dysphagia, measuring blood lipid levels, and counseling patients on smoking. "Stroke nurses play a key role in dysphagia screening and patient education," lead author Mary G. George, a medical officer at the CDC, told AJN.

Despite such improvements, one remaining area of concern is getting patients to hospitals fast enough to benefit from thrombolytic therapy with tissue plasminogen activator (tPA), which is only approved for use in the early stages of treatment. If given within three hours of symptom onset in patients with ischemic stroke, which accounted for more than half of all strokes recorded in this analysis, tPA has been shown to improve outcomes. Unfortunately, only 9% of ischemic stroke patients received tPA. One reason so few patients arrived at the hospital in time could be because only 47% of patients used emergency medical services (EMS), the fastest mode of transportation of patients to a hospital, indicating a need to educate the public on the symptoms of stroke and the importance of calling EMS at the earliest signs of stroke onset.

"Although we see an ongoing need to improve the quality of care in some areas," George said, "we know that stroke nurses have made great contributions in coordinating patient care, making sure that care is delivered in a timely manner, and establishing processes to make sure that every patient gets the right care."

Carol Potera