Telemedicine Offers Hope for Stroke Sufferers

Feb. 21, 2002 -- Stroke is the third leading cause of death and the No. 1 cause of disability in the United States. Every year there are about 700,000 new strokes, costing $50 billion.

Approximately 20 percent of patients will die, and of the 15 percent to 30 percent who survive but are disabled, many end up in a nursing home. On average, someone in the United States has a stroke every 53 seconds.

However, there is hope. A clot-busting drug known as tissue plasminogen activator, or t-PA, restores blood flow to the brain and makes some stroke sufferers get better right away. It is the only Food and Drug Administration- approved therapy for acute ischemic stroke.

Repeated studies have shown dramatic improvements in stroke recovery in patients treated with t-PA therapy when it is given by stroke experts, but other studies have shown that this therapy can be very dangerous if given by those without adequate training or expertise.

When given correctly, t-PA not only makes people better, but also generates a cost savings to the health-care system of approximately $4,000 for every patient treated, regardless of how each patient recovers.

Treatment Limitations

The problem is that people who live in small towns and do not have access to a stroke center may not have access to this latest approach to acute stroke therapy.

In a large study conducted at major medical centers, 70 percent of patients who would have been eligible for t-PA drug therapy did not receive it because they arrived at the hospital too late or went to centers that could not provide t-PA treatment.

Because it's expensive and impractical to transport patients who might be having a stroke, it makes much more sense to bring the doctors to the patient immediately. For this reason, a few centers in the United States have created a TeleStroke program that uses high-speed videoconferencing and remote viewing of brain scans to bring a "virtual stroke expert" to the bedside.

Expansion of this program could enable the treatment of the millions of Americans who live in areas without access to acute stroke expertise and risk the consequences of death and long-term disability from strokes.

The STOP Stroke Act

If a TeleStroke system improves recovery in stroke patients, the cost savings will be measured by fewer people with disabilities, fewer medical illnesses and less need for nursing home care.

TeleStroke systems can also lower costs by preventing the unnecessary treatment or transfer of patients who do not need t-PA therapy. By supporting the community hospital with stroke expertise, TeleStroke allows the community hospital to function more like an academic hospital and could save the United States millions of dollars a year.

The STOP Stroke Act of 2001 provides funding for building the systems we need to improve stroke care across the board. It has passed the Senate and now is under consideration in the House. It includes provisions to make sure that stroke care reaches all Americans, especially those who are out of the reach of academic hospitals.

Let your voice be heard. Make sure that stroke care receives the funding it needs to reach you and your loved ones in a time of need.

In the 1950s, patients with chest pain and heart attacks were slow to arrive at hospitals and doctors had little help to offer. Now emergency physicians routinely administer clot-buster medication to treat heart attack victims all over the country and deaths from heart attacks have dropped dramatically.

With TeleStroke programs and public education, we can close the gap between what we know and what we do for patients with acute strokes.

Dr. Lee Schwamm is an assistant professor of neurology at Harvard Medical School, an associate program director at the Massachusetts Institute of Technology-Clinical Research Center, an associate director for the Acute Stroke Service at Massachusetts General Hospital and director of the CIMIT National Stroke Program.

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