AHA/ASA政策声明阐述成功卒中治疗的要素

美国心脏协会(AHA)和美国卒中协会(ASA)在联合发表的政策声明中指出，政府机关、医疗部门和医学权威应当支持卒中中心的建立和认证，并且应当使用远程医疗系统来改善治疗。这份题为《卒中治疗系统中的交互》的政策声明发表在8月29日《卒中》杂志上(doi:10.1161/STR.0b013e3182a6d2b2)。

该声明中另有一项建议描述了当前美国卒中治疗系统所需的要素，包括建立一个提供普遍可及的卒中后治疗的系统和设计一套反映当前卒中治疗指南的医院规程。


Randall Higashida博士

主要作者、AHA倡议协调委员会主席Randall Higashida博士和共同主席Mark Alberts博士在声明中指出，一套功能齐备的卒中治疗系统可使美国死亡人数减少2万，可使全球死亡人数减少约40万。而且这样一套系统还能减少卒中后残疾，从而改善生活质量和减少患者、家人、保险公司及政府的支出。


Mark J. Alberts博士

这份声明共提出了10项建议，除了前面提到的3项之外，还包括拨打911、不同科室医务人员之间的交互、患者转运、出院和康复、医保赔付以及相关法律事宜等。

爱思唯尔版权所有  未经授权请勿转载

By: ELIZABETH MECHCATIE, Cardiology News Digital Network

Government agencies, health care authorities, and medical leaders should support the formation and certification of stroke centers and the use of telemedicine systems to improve care, according to a policy statement issued by the American Heart Association and the American Stroke Association.

Other recommendations in the statement – which describes the components needed for a modern system of stroke care in the United States – involve establishing a system that provides universal access to poststroke care and developing hospital protocols that reflect current stroke care guidelines.

These are among the 10 policy recommendations that describe concepts and elements to be included in "stroke systems of care that are intended to optimize patient care and management processes and improve patient outcomes, are practical to implement, and are supported by existing clinical data or expert consensus opinion," the statement said.

The paper, "Interactions Within Stroke Systems of Care," was published Aug. 29 in Stroke (doi:10.1161/STR.0b013e3182a6d2b2).

The lead authors are Dr. Randall Higashida, chair of the American Heart Association Advocacy Coordinating Committee, and Dr. Mark Alberts, cochair.

A "fully functional" system of stroke care would reduce the number of deaths by 20,000 in the United States and by about 400,000 worldwide. In addition, such a system would reduce disability after strokes, which would improve quality of life and would lower costs for patients, their families, third-party payers, and governments, according to the statement.

Recommendations for the main elements of a stroke system of care range from calling 911 to the interactions of different types of health care professionals involved in the care of patients in a stroke center to discharge and rehabilitation.

The first recommendation advises medical professionals and public health leaders to "design and implement" public education programs about stroke symptoms and the need to seek emergency care quickly.

Since designated stroke centers have been shown to improve patient care and outcomes, including lower death rates, another recommendation is for health care professionals, medical leaders, and government agencies to support the formation, operation, and certification of such centers. The statement includes descriptions of different acute inpatient stroke care facilities, including a comprehensive stroke center, primary stroke center and acute stroke–ready hospital.

In addition, hospitals caring for stroke patients "within a stroke system of care should develop, adopt and adhere to care protocols that reflect current care guidelines" that have been established by national and international professional organizations, and state and federal agencies.

Governments, payers, vendors, and health care institutions should support the use of telemedicine resources and "telestroke" systems to ensure that stroke patients in a variety of settings have adequate around-the-clock care, according to another recommendation that noted the "limited distribution and availability of neurological, neurosurgical, and radiological expertise."

Other recommendations pertain to transfer protocol and criteria, reimbursement issues, legal issues in stroke care, and rehabilitation.

The authors state that local and regional health care providers and government officials and related agencies should adopt the procedures and policies described in the statement. The statement concludes that "any system of care will only be as strong and efficient as its weakest link," and that by following the principles in the statement, "we hope to minimize or eliminate any weak links."

Dr. Higashida, chief of the division of interventional neurovascular radiology at the University of California San Francisco Medical Center, had no disclosures. Dr. Alberts, professor of neurology and neurotherapeutics at the University of Texas Southwestern Medical Center, Dallas, disclosed having received honoraria or serving on the speakers bureau for Genentech. Of the 15 remaining members of the committee, 6 had no disclosures. The remaining committee members’ disclosures included serving as a consultant or adviser to Genentech, W.L. Gore, Covidien, and/or the National Stroke Association, and receiving grants from the National Institutes of Health and/or the National Institute of Neurological Disorders and Stroke, the National Stroke Association, and Genentech.