Comprehensive stroke centers reduce mortality risk in patients treated for hemorrhagic stroke

May 7 2015

New research published today in the Journal of the American Heart Association indicates that patients who are treated for hemorrhagic stroke at a comprehensive stroke center are more likely to receive specialized treatment, reducing the risk of mortality. Physicians at the Cardiovascular Institute of New Jersey at Rutgers Robert Wood Johnson Medical School and the Comprehensive Stroke Center at Robert Wood Johnson University hospital conducted the study utilizing the Myocardial Infarction Database Acquisition System (MIDAS) to determine that patients admitted to comprehensive stroke centers, as well as patients transferred to comprehensive stroke centers within 24 hours of initial hospitalization, were more likely to survive.

Stroke is a leading cause of death and disability in the United States according to the American Heart Association and American Stroke Association Previous research has shown that comprehensive stroke centers improve clinical outcomes and reduce disparities in ischemic stroke, which is caused by a blockage in blood vessels. The new research reveals that the same may be true for patients who experience hemorrhagic stroke, when there is bleeding in or around the brain, which has a mortality rate of 40 to 50 percent.

"Hemorrhagic stroke is complex and requires skilled medical interventions to improve a patient's outcome," said James S. McKinney, MD, assistant professor of neurology at Rutgers Robert Wood Johnson Medical School and medical director of the Comprehensive Stroke Center at Robert Wood Johnson University Hospital and lead author of the study. "Our research indicates that the use of neurosurgical and endovascular treatments that are available at state-designated comprehensive stroke centers are associated with lower mortality in patients with hemorrhagic stroke."

Studying demographic and clinical data available through MIDAS, a state-wide database of hospitalizations for myocardial infarction (heart attacks), stroke, other vascular diseases, and deaths from 1990 to the present, the researchers reviewed more than 36,000 anonymous patient records from 1996 to 2012. The review included admissions and discharge data for 87 non-federal New Jersey hospitals, each designated as a comprehensive stroke center, primary stroke center or nonstroke center, by the New Jersey Department of Health and Human Services. In New Jersey, comprehensive stroke centers must be staffed 24-hours-a-day, seven-days-a-week, with a neurosurgical team including diagnostic and interventional neuroradiologists.

Despite the availability of 13 designated comprehensive stroke centers in New Jersey, the study noted that only 40 percent of patients were admitted to a comprehensive stroke center during the study time period from 1996 to 2012, while the remaining 60 percent were admitted to either a primary stroke center or nonstroke center.

"Based on the evidence presented in our study, we believe that more patients can survive hemorrhagic stroke with better utilization of the state's comprehensive stroke centers," said Dr. McKinney.

According to Dr. McKinney, variables other than comprehensive treatment contributed to improved outcomes, including age.

"In our analysis, patients admitted to comprehensive stroke centers were, on average, five years younger than patients admitted to other hospitals," said Dr. McKinney. "In addition, patients transferred to comprehensive stroke centers were significantly younger in age than patients who remained in primary stroke or nonstroke centers."

Source: Rutgers Robert Wood Johnson Medical School