Overview of key factors in improving access to acute stroke care

Neurology. 2012 Sep 25;79(13 Suppl 1):S26-34. doi: 10.1212/WNL.0b013e3182695a2a.


Background: Despite recent advances in acute stroke therapy, only a small proportion of patients with acute ischemic stroke receive IV and endovascular revascularization therapies. This article provides an overview of factors influencing access to stroke therapy.

Methods: The key factors influencing access to stroke care highlighted during the Society of Vascular and Interventional Neurology (SVIN) roundtable meeting are summarized. Pertinent selected references on prehospital, hospital, and legislative and economic factors influencing access to stroke care, from the Medline database (between 1995 to 2011), are included. A brief summary of these key factors in improving access to stroke therapy is provided.

Results: Prehospital factors include the community; education of hospital administrators and health care personnel; dispatchers; the medical transport system; and preparedness and stroke education of emergency medical services (EMS). Stroke-ready hospitals and networking with other regional tertiary stroke hospitals play important roles in increasing access to stroke care. In addition, legislation at the state and federal levels is a key factor in providing high-quality, timely access to stroke care for the population in general. Strategies to facilitate access to stroke therapy are critical to improving mortality and functional outcome and increasing the proportion of patients treated by systemic thrombolysis and endovascular approaches.

Conclusion: This is a brief overview and summary of selected factors influencing access to stroke care. These factors are divided into prehospital, hospital, legislative, and economic categories. Multilevel education of the population, public health care personnel, hospital preparedness, and legislative and economic factors are important in improving access to stroke care.

Publication types

  • Review

MeSH terms

  • Emergency Medical Services / trends
  • Endovascular Procedures* / trends
  • Health Services Accessibility* / trends
  • Humans
  • Stroke / diagnosis
  • Stroke / epidemiology
  • Stroke / therapy*
  • Telemedicine / trends
  • Tertiary Care Centers / trends
  • Thrombolytic Therapy* / trends
  • Time Factors