As reported this month in the Journal of the American Heart Association, an analysis of 66 patients treated in mobile stroke units deployed by NewYork-Presbyterian Hospital found that the 29 patients found to have suffered a stroke were treated more quickly that nine of 19 patients who were taken to the hospital by an ambulance.
Mobile telestroke units, most often ambulances equipped with mHealth and telemedicine tools, have been deployed in several cities as health systems look to speed up care for those experiencing a stroke. The connected health platforms enable first responders to connect in real time with neurologists at the nearest hospital, exchanging data that can be used to more quickly identify a stroke and start life-saving treatment.
The goal is to reduce the “door-to-needle” time, or the time between identifying a stroke and administering intravenous tissue plasminogen activator (tPA). The recommended guideline is within 60 minutes, though studies have found that less than 30 percent of US patients are treated within that time.
In the NYP study, researchers studied patients from the METRONOME (Metropolitan New York Mobile Stroke) registry with suspected acute ischemic stroke who were transported mobile telestroke units used by NYP in Manhattan between October 2016 and September 2017. The telestroke program was launched by the health system in a partnership with the Fire Department of New York in 2016.
The study found that the mHealth platform received dispatch-to-thrombolysis care in about 61 minutes, compared to an average of 91 minutes for those transported by a conventional ambulance.
“When it comes to stroke treatment, 30 minutes can be the difference between making a full recovery from a stroke and living independently, or becoming disabled and needing help with the activities of daily living,” Matthew E. Fink, MD, the study’s lead author, a chair of neurology and the Louis and Gertrude Feil Professor in Clinical Neurology at Weill Cornell Medicine in New York and neurologist-in-chief at NewYork-Presbyterian/Weill Cornell Medical Center, told the Journal of Emergency Medical Services.
“Given the public health implications of faster stroke treatment, these results suggest that mobile stroke units may represent a potentially beneficial addition to stroke systems of care in dense cities,” Fink and his colleagues said in the study.
While this may be the first study to highlight the use of mobile health units, it isn’t the first to demonstrate the value of telehealth in stroke care.
In late 2017, Kaiser Permanente published a study of its Stroke EXPRESS (EXpediting the Process of Evaluating and Stopping Stroke) program, serving some 20 hospitals in northern California. The study found that a telehealth platform connecting those hospitals to specialists helped care providers treat patients within the 60-minute window 87 percent of the time.
More importantly, according to the Kaiser Permanente study, 73 percent of stroke patients in those hospitals were treated within 45 minutes and 41 percent were treated within 30 minutes; the average “door-to-needle” time was 34 minutes.
With the primary barrier to effective treatment being access – specifically, time spent transporting a patient to a hospital and having him or her seen by a neurologist – providers are turning to telehealth and mHealth to bridge that gap in time. This could be through a telemedicine platform that links rural and remote hospitals and clinics to larger health systems with specialists on hand, or in mobile health units that connect first responders at the scene back to the hospital.
“Processes that used to happen sequentially during a stroke alert, one after another, are now happening at the same time, allowing us to quickly, safely and confidently provide evaluation and treatment with intravenous r-tPA to stroke patients who can benefit,” said Jeffrey Klingman, MD, chairman of the Chiefs of Neurology for Kaiser Permanente Northern California and a co-author of the study.
“We will be able to give patients the same medication at their homes that they would receive in an emergency department,” adds David Fiorella, a neurointerventionist at Long Island’s Stony Brook University Hospital and director of the cerebrovascular program at the university’s Cerebrovascular & Comprehensive Stroke Center, which launched its own mobile telestroke program earlier this year.