New Analysis Finds 96% of People in United States Live Within 1 Hour of Stroke Care

February 3, 2022—The American Stroke Association (ASA) announced the presentation of a study that found that nearly all people in the United States can access life-saving stroke care within 1 hour by ambulance. The preliminary research from this study will be presented at the ASA’s International Stroke Conference 2022 held on February 8-11 both virtually and in New Orleans, Louisiana.

According to ASA, the study investigators sought to provide an up-to-date summary of stroke centers and emergency departments equipped with telestroke units and determine the proportion of the United States population with access to these facilities. The study was funded by the Agency for Healthcare Research and Quality and the National Foundation of Emergency Medicine.

The investigators accessed data from the 2020 United States Census Bureau combined with the 2019 National Emergency Department Inventory, which is a compilation of all emergency departments across the nation. Data from these sources included location, stroke center status, and availability of telestroke services.

Using the 2019 National Emergency Medical System Information data, the investigators calculated driving times from every census block in the country to the nearest emergency department with telestroke capacity or the nearest acute-stroke-ready, primary, or comprehensive stroke center.

As summarized by ASA, the analysis found:

• Of the 5,587 emergency departments nationwide, 46% are in an acute-stroke-ready hospital or stroke center. Of these, 55% also have telestroke services.
• Of the 3,024 (54%) emergency departments that are not in an acute-stroke-ready hospital or stroke center, 36% have telestroke services.
• Researchers estimate that 91% of the United States population can reach an acute-stroke-ready hospital or stroke center within 1 hour by ambulance, receiving life-saving care; if telestroke-capable emergency departments are included, that number rises to 96%.
• The percentage of the population without access to a stroke center or telestroke-capable emergency department varied by region, from 1% in the Middle Atlantic to 9% in the West Mountain portions of the country (Arizona, Colorado, Idaho, New Mexico, Montana, Utah, Nevada, and Wyoming). 

The ASA press release noted that 10 years ago, national data suggested that approximately 20% of people in the United States could not access the level of timely stroke care that may save their life or prevent future disability. Since then, the addition of more hospitals with the specialized staff, tools, and resources to provide advanced stroke care and the increased use of telestroke services in hospitals across the country have connected small and rural hospitals with stroke neurologists at specialized stroke care centers ready to provide remote stroke consultations around the clock.

Kori S. Zachrison, MD, lead investigator of the study, commented in the ASA press release, “Investments in improving stroke systems of care have been successful, and we are seeing improved access to stroke expertise and improved health care for patients who are remote from centers of expertise, so it’s a message of hope.”

Dr. Zachrison, who is an Associate Professor of Emergency Medicine at Massachusetts General Hospital and Harvard Medical School in Boston, Massachusetts, continued, “There is a narrow window of time for delivering disability-reducing stroke treatments. Improving poststroke outcomes for patients depends on a patient’s ability to access that care. With increased implementation of telestroke, optimal stroke care has been made possible for an estimated 96% of the United States population, which is remarkable considering the geographic span of our country.”

Dr. Zachrison stated further, “Unfortunately, geography plays a role in access to health care—if you live in rural areas, your access to advance stroke care is not as available as if you live in the middle of Boston or New York City, for example. Through telestroke, we have been able to begin to close geographic disparities and improve access to optimal care by bringing stroke expertise to patients where they are—this is profound.”

The ASA noted that in May 2020, stroke experts from the American Heart Association’s Stroke Council issued new guidance titled “Pre-Hospital Triage of Acute Stroke Patients During the COVID-19 Pandemic” to establish protocols that optimize handling suspected stroke cases before they arrive at a hospital during the ongoing COVID-19 crisis and future pandemics. The guidance was published by Mayank Goyal, MD, et al in Stroke (2020;51:2263-2267).

One of the goals included increased interactive videoconferencing (telestroke) networks to assess and provide treatment as quickly as possible. An ASA Policy Statement, “Recommendations for the Establishment of Stroke Systems of Care: A 2019 Update” also recognized the value and cost-effectiveness of telestroke in providing more equitable access to advanced stroke care. The document was published by Opeolu Adeoye, MD, et al in Stroke (2019;50:e187-e210).