Tuesday, July 07, 2015

Where are you? And why should that matter for stroke treatment?

Place can have a lot to do with your health. That's been demonstrated, and experts have talked about diet, access to providers, lifestyles and more.

But a recent study has its own author puzzled about baffling disparities in stroke treatment across the United States:
In the bottom one-fifth of the hospital markets patients received no tPA. In the top one-fifth of markets 9% of patients received clot-busting drugs. In Asheville, NC and Stanford, CA as many as 14% of patients received IV tPA or an intra-arterial treatment using tPA or another drugs.
There were only minor improvements in treatment levels for patients in regions with certified primary stroke centers, or where emergency medical services drove patients further to get stroke treatment. Older patients, minorities, and women were less likely to get tPA regardless of where they lived, the study showed.
James Burke, MD, senior author of the study and an assistant professor of neurology at UM, says he's hard pressed to explain these disparities in treatment regimens.
"My honest answer is I don't know. It's a whole bunch of different things. My guess is that this is probably a very complicated nut to crack," he says.
The study was about the use tissue plasminogen activator, or tPA, the primary treatment for clot-caused strokes. It's been around about nine years.

The study is a bit chilling to me - if there's such a thing, I was in the right place at the right time when I had my stroke in 1998.

It does show that we've got a long way to bring consistent, correct stroke treatment everywhere.

The areas in green and blue had the highest rates of tPA use, and the areas in red, orange and yellow had the lowest. The black areas had fewer than 50 strokes a year. Map from the University of Michigan Health System.

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