American Heart Association Publishes Statement on Telemedicine for Stroke
July 1, 2009—In Stroke, the American Heart Association has published a policy statement by Lee H. Schwann, MD, et al that provides recommendations for the implementation of telemedicine within stroke systems of care (2009;40:2635–2660).
According to the statement, telestroke is defined as consultations that involve a physician who is a stroke expert using a high-quality, bidirectional audio and videoconferencing system to interact with a bedside provider and/or patient/caregiver for the purposes of delivering stroke care or advice. It is not a new medical therapy per se; rather, it is a method used to overcome barriers to the delivery of proven, evidence-based therapies that might otherwise be unavailable for stroke patients. In this context, telemedicine can help to establish an organized stroke systems-of-care model (SSCM) and increase utilization of intravenous thrombolysis and stroke unit care. Telestroke can enable the initiation of cost-effective interventions that have been proven to reduce complications and stroke recurrence and can identify and facilitate transfer of patients in the community for specific tertiary care interventions such as neurointensive care, decompressive surgery for life-threatening, space-occupying cerebral infarction, and prompt surgical or endovascular repair of ruptured cerebral aneurysms.
Regarding endovascular therapy and the use of telemedicine for stroke treatment, the statement notes that catheter-based reperfusion (eg, chemical thrombolysis, thromborrhexis, clot retrieval, angioplasty, and/or stenting) may confer benefit in carefully selected patients with acute ischemic stroke who are not eligible for intravenous tissue plasminogen activator thrombolysis or who have failed to respond to it.
Although the window for initiation of catheter-based mechanical clot retrieval may be up to 8 or 9 hours after symptom onset, there are currently only 385 interventional neuroradiologists in the United States practicing in 238 hospitals in 45 states. The ability to increase the proportion of ischemic stroke patients who are transported to centers that can provide reperfusion therapy will rely on increased training of appropriate specialists, although it might result in significant cost savings for the healthcare system that could potentially offset the initial capital costs associated with improved diagnostics or interfacility transport.
Also in Stroke, the American Heart Association/American Stroke Association published a scientific statement by Dr. Schwamm, et al that is a review of the evidence for using telemedicine within SSCMs (2009;40:2616–2634). As noted in the statement, it aims to provide a comprehensive and evidence-based review of the scientific data evaluating the use of telemedicine for stroke care delivery and to provide consensus recommendations based on the available evidence. Evidence-based recommendations are included for the use of telemedicine in general neurological assessment and primary prevention of stroke, notification and response of emergency medical services, acute stroke treatment including the hyperacute and emergency department phases, hospital-based subacute stroke treatment and secondary prevention, and rehabilitation.