Trends in Stroke Recognition and Treatment

Acute stroke is the third leading cause of death in the United States behind cardiovascular disease and cancer. Approximately 700,000 Americans experience a new or recurrent stroke every year, and 150,000 annual deaths are attributed to strokes. It is the second leading cause of death worldwide and the third leading cause of death in the U.S., according to the American Heart Association.

Acute stroke is the primary cause of long-term disability in the United States. Of the estimated 5.5 million Americans that have survived a stroke, nearly one million survivors report stroke-related functional difficulties. In 2008, over $65 billion was spent on stroke-related medical costs and disability in the U.S. The average lifetime cost per stroke is estimated at $140,000; this figure includes costs for stroke hospital care, rehabilitation and ongoing care related to lasting functional deficits.

Recent stroke information from the medical research community reveals the incidence of acute stroke is highly subject to age, sex and ethnicity. Risk of stroke doubles after the age of 55, and stroke is more common in men than women until the age of 80; after age 80, the incidence for women exceeds the rate for men. Over a lifetime, women have more strokes than men because of the greater longevity of women.

From 1994 to 2004, the death rate from strokes declined by 20 percent. This decrease can be attributed to early recognition of symptoms, improved prehospital stroke care, and collaborative protocols for stroke hospital management and acute stroke treatment.

The most recent findings from the medical community suggest that approximately 80% of neurons die within three hours of the time that oxygen is cut off and acute stroke occurs, necessitating rapid action to preserve brain tissue and mitigate long-term disability in the patient. Since ‘time is brain’ when it comes to responding to and treating stroke, the National Institute of Neurological Disorders and Stroke (NINDS), a branch of the National Institutes of Health (NIH), has outlined target times for acute stroke treatment. According to the NINDS, no more than three hours should elapse between the onset of stroke symptoms and signs to the administration of appropriate acute stroke treatment to ensure improved patient outcomes.

In order to save time—and potentially brain function—in patients who have suffered a stroke, the American Heart Association and the American Stroke Association have developed a community-oriented “Stroke Chain of Survival” that links specific actions to be taken by patients and family members with recommended actions by stroke prehospital care providers, emergency department (ED) personnel and stroke hospital inpatient services. The “Stroke Chain of Survival” is characterized by four sequential stages, including:

Rapid recognition and reaction to acute stroke warning signs;
Rapid emergency medical services (EMS) dispatch;
Rapid EMS system transport and pre-arrival notification to the receiving stroke hospital; and
Rapid diagnosis and treatment in the hospital.

Efforts have also been made to streamline stroke prehospital care and stroke hospital inpatient care provided through stroke certification requirements for medical professionals practicing in adult medicine. Certification courses include Adult Cardiac Life Support (ACLS), which has acute stroke training and acute stroke treatment components, and stroke certification courses. These certifications ensure that all medical professionals throughout the “Stroke Chain of Survival” are well acquainted with stroke information and the protocols for recognizing and treating stroke, thus eliminating the chance that precious time within the three-hour window outlined by the NINDS will be wasted.

Despite collaboration in the medical community to improve the efficiency and effectiveness of recognition, response and acute stroke treatment, acute stroke remains a devastating illness with limited treatment options. These limited options have prompted the healthcare community to continue its work to mitigate risk factors by promoting awareness of stroke information and prevention.

For more information about acute stroke certification, visit the overview of stroke courses offered online.

The information included in this article is based on the 2020 guidelines for CPR, first aid and advanced cardiovascular care.