How we can build a brighter future for stroke patients

A year ago, I wrote about how technology is rapidly transforming stroke care, a welcome development in combating a disease that claims approximately 6 million lives around the world each year [1]. I promised to revisit this important topic to examine the latest advances in how the medical community is dealing with this life-altering disease. In this article, I take a closer look at the full cycle of care and how we could optimize workflows to help improve how we diagnose and treat stroke.

Across the globe, smart solutions are put to work by world-class stroke centers, to support staff in delivering the best outcomes they can for their patients. My fellow physicians don’t need me to make the case for why improving health outcomes is always our primary goal. 

The quadruple aim in health care necessitates us to improve the patient experience while reducing cost of care. Health systems are increasingly working under value-based care models. This means they’re being measured not only on health outcomes, but also on what matters to the patient – things like their experience during diagnosis, treatment and quality of life.

Prevention first

With key treatable or modifiable risk factors for stroke including hypertension, tobacco use, physical inactivity and obesity, it’s not surprising that up to 80% of strokes could be prevented through lifestyle changes [2]. Another leading risk factor for stroke is atrial fibrillation (Afib), widely regarded as a global public health problem: 33.5 million people around the world are currently living with this condition that increases their risk of stroke five-fold [3, 4]. 

If we can treat Afib more effectively and efficiently, we can reduce the likelihood of stroke happening in the first place. Coupling our image-guided therapy expertise with our novel KODEX-EPD system has the future potential to address the key unmet need of real-time therapy assessment during Afib ablation procedures, lowering its recurrence and helping us get ablation ‘first time right.’

Reducing time to treatment

If a patient does have a stroke, every 30 minutes’ delay before treatment reduces the chance of a good outcome by 14% [5]. We know time is brain. Every minute of cerebral ischemia results in the death of 2 million neurons [6]. Each hour of delay ages the brain by 3.6 years compared to a normal-aging brain [7]. That’s why I think it’s so crucial to be able to diagnose patients and get them the intervention they need, as swiftly as possible. 

We’re working to shorten the path to diagnosis and treatment in several ways – before the patient even gets to the Azurion interventional suite. We support hospitals in leveraging their resources to quickly deliver life-saving interventional procedures to those who need them most. We are working with leading stroke centers to develop innovations, aimed at improving the image quality further, and to improve workflow to shorten re-perfusion time after ischemic stroke [8] (you can learn more about this here). 

Improved understanding, better outcomes

While tracking measurements like door-to-thrombectomy time is critical, I believe that looking at that metric alone may be shortsighted. The value for the patient is created across the full cycle of care – from their pre-hospital experience, throughout their time in the hospital, as they are teed-up for discharge, and during their recovery period at home. Our experience flow mapping technique helps to build a vivid picture of what’s going on, establish what’s working well and what’s not, and, ultimately deliver more targeted solutions. 

Rural communities and those with underequipped health facilities are typically most in need of improvement. Thankfully, new solutions in telemedicine are improving access to care, enhancing diagnosis, reducing costs and improving outcomes. Telestroke programs, where stroke experts work with the emergency team in rural areas over the phone or via video to help diagnose and recommend treatment, have been shown to cut ‘stroke-to-needle’ time in half [9]. Indeed, our telehealth partnership with Northwell Health saw ICU mortality reduced by up to 20% and double the number of patients assessed and prescribed the life-saving clot-busting drug tPA [10].

What’s next?

The DAWN and DEFUSE 3 trials have initiated new treatment pathways that are set to revolutionize how we can treat stroke patients. The widening indications for thrombectomy allow us to deliver mechanical thrombectomy to more patients than ever before, potentially reversing the devastating effects of stroke and significantly improving quality of life. On the other hand, these trials have resulted in a sharp increase in patient volumes as many more patients are now eligible candidates for stroke thrombectomy. Thus, we must improve efficiency in care delivery, while simultaneously decreasing time to thrombectomy. 

The upcoming WE-TRUST ‘Workflow optimization to rEduce Time to endovascular ReperfUsion in Stroke Treatment’ study will assess the impact of a Direct to Angio Suite (DTAS) workflow on stroke patient outcomes. Several studies [11, 12, 13] have already indicated that having this ‘one-stop-stroke shop’ DTAS workflow can sizably reduce time to treatment and improve outcomes. 

As I mentioned a year ago, the fight against stroke remains one that must be waged on multiple fronts and I am more enthused than ever to see such rapid progress in this fast-moving field of stroke therapy.