By Victor Allyn Aletich, Sameer A. Ansari and Demetrius Lopes
There is a killer at work in Illinois. In 2010, stroke killed more than 5,000 people in the Land of Lincoln, making it the fourth leading cause of death. Nationally, the damage is just as alarming. According to the U.S. Centers for Disease Control (CDC), almost 800,000 people suffer a stroke each year, and more than half are women. In fact, stroke is the fourth leading cause of death overall, but the third leading cause of death for women. Despite these numbers, many women remain unaware of their risk.
Consider this: while 425,000 women suffer from stroke each year, a recent study found that less than one in three women could name more than two primary stroke symptoms. To address this lack of knowledge about the impact of stroke on women, the American Heart Association (AHA) and the American Stroke Association (ASA) have recently been promoting guidelines aimed at preventing strokes in women.
If the past ten years or so is any indication, this initiative should yield results. From 2000 to 2010, education on risk factors, symptoms and the optimal treatment window for stroke shined a spotlight on stroke that worked its way into the public consciousness. It’s not surprising then that within that same time period death rates declined—falling more than 35 percent. But the war on stroke has been waged on other fronts as well. Since FDA approval of the “clot-busting” tissue plasminogen activator (tPA) in 1996, scientific advancements have introduced neurointerventional techniques and devices that have expanded the treatment window from three hours to eight. Stroke care delivery has improved, with emergency transport guidelines and certifications that define specific personnel, equipment and treatment criteria that hospitals must meet to be deemed a primary or comprehensive stroke center.
Illinois has also taken on the challenge. The Illinois General Assembly in 2009 passed legislation creating stroke systems of care and two years later created the 24-member Illinois House Emergency Medical Services (EMS) Task Force—both of which have played a critical role in helping to reduce the morbidity, mortality and economic burden of heart disease and stroke. The Chicago Area Stroke Taskforce has successfully implemented a stroke system of care for the region, and in 2011, a citywide policy was enacted to ensure that emergency medical service personnel are equipped to appropriately assess patients and immediately transfer them to the closest of 18 certified stroke centers.
Rush University Hospital, Northwestern Memorial Hospital and the University of Illinois Medical Center at Chicago are three such centers. We attain successful outcomes by bringing together physicians from many different disciplines, all of whom contribute their expertise to provide appropriate treatment within a narrow time window. Stroke, perhaps more so than any other disease, requires this multi-disciplinary effort to maximize quality patient care.
While the results of our efforts in individual institutions as well as state-wide are commendable, there is still more work to be done. Neurointervention—its success evident in thousands of lives saved—must continue to be evaluated in clinical trials. Patient registries are critical to ensuring process improvement and better outcomes. And hospitals, regardless of cultural differences and history, must embrace coordinated care models that leverage the expertise of specialists from various backgrounds to ensure optimal patient care.
Rising to the challenge of improving stroke care delivery, our hospitals are hosting the Society of NeuroInterventional Surgery in Chicago this week as part of its national stroke summit tour to advance the dialogue among the “stroke team” professionals involved in the diagnosis, treatment and management of stroke. These summits will welcome first responders, emergency room physicians, radiologists, neurologists, neurointerventional surgeons, and others who specialize in stroke treatment to discuss trends, treatment advancements and best practices in stroke care in the hospital setting.
Stroke affects nearly 9,000 people in our city annually, and someone suffers a stroke every 40 seconds in the U.S.—our wives, mothers, aunts and sisters bearing the brunt of this deadly disease. But, researchers, physicians, advocates and lawmakers have proven themselves undeterred in the face of this enemy. We are proud of our work in Chicago and statewide to reduce the impact of stroke. Building on our accomplishments, and with this new initiative to promote collaboration and strengthen the stroke team within the hospital environment, the battle is ours to win.
Dr. Victor Allyn Aletich, is chief, Section of Endovascular Neurosurgery at University of Illinois College of Medicine at Chicago; Dr. Sameer A. Ansari is a neurointerventional surgeon at Northwestern Memorial Hospital; and Dr. Demetrius Lopes is the Surgical Director of the Rush University Comprehensive Stroke Center. All three physicians are members of the Society of NeuroInterventional Surgery.