Margaret Tremwel, MD, a neurologist with Sparks Health System in Fort Smith is shown giving a stroke telemedicine consultation

Risk Factors Need to be Addressed to Lower Incidence of Stroke

In the past two and a half years the Arkansas SAVES telestroke program has instituted dramatic improvements in how quickly and effectively stroke patients, even in rural parts of Arkansas, can receive life-saving treatment. The program sponsored by University of Arkansas for Medical Sciences (UAMS) has expanded to 27 community hospitals connected to two hubs that provide telemedicine consultations with neurologists.

There is no doubt that the program is savings lives, improving the health outcome for stroke victims, and possibly reducing costs for medical treatment and rehabilitation, said Salah G. Keyrouz, MD, medical director, Arkansas SAVES telestroke program and chief of the Division of Neurocritical Care and Stroke at UAMS. Since inception of the program in November 2008, they have consulted on more than 500 patients, and administered tPA to about 140 patients.

The program available 24 hours per day is a partnership between the UAMS Center for Distance Health, the Arkansas Department of Human Services and Sparks Health System in Fort Smith.

UAMS has also created a “stroke pathway,” a program by which physicians, nurses, and other personnel are mobilized when a patient who was at one of the SAVES spoke hospitals is transferred to UAMS.

“Certain patients are transferred to undergo more lifesaving interventions because we don't think they will improve with intravenous tPA only,” Keyrouz said. “The pathway was created four months ago, and we have so far used it seven or eight times.”

It rarely makes headlines when someone has a stroke and through the SAVES program is saved from disability or death. But UAMS found a unique way to publicize the benefits of SAVES while raising stroke awareness with Strike Out Stroke Night at an Arkansas Travelers game in late May in North Little Rock. Thousands of baseball fans watched as a helicopter carrying Keyrouz landed just outside the Dickey-Stephens Park. Keyrouz got out and gave a baseball to stroke survivor Ticia Covington of Searcy, who ran it to a group of other stroke survivors who handed it off to UAMS Chancellor Dan Rahn, MD. Rahn then threw the game’s ceremonial first pitch.

Keyrouz said stroke patients who are diagnosed by a stroke neurologist within 4.5 hours of symptoms and treated with tPA are much more likely to have a better outcome and full recovery. That was the case with Covington, an elementary teacher who after treatment at White County Medical Center was symptom-free and back in the classroom in a matter of weeks.

The four other living testaments to the success of SAVES who participated in Strike Out Stroke Night were:

• Rev. Charles Kendrick of Alexander, treated at Saline Memorial Hospital in Benton, had a speedy recovery and was able to return to preaching and hobbies.
• Linda Cole of Jacksonville, who received care at St. Vincent Infirmary North in Sherwood, was able to resume her favorite pastime–fishing.
• After receiving successful treatment for her stroke at Arkansas Methodist Medical Center in Paragould, Marica Griffith has become a community stroke education advocate.
• First Baptist Church in North Little Rock Pastor Rev. William Robinson experienced a major stroke while guest-preaching at a church in West Memphis. He was treated at Crittenden Regional Medical Center, and has returned to his congregation and is a champion of stroke prevention, early recognition and intervention.

A similar Strike Out Stroke Night was held earlier this year at a Northwest Arkansas Naturals game in Springdale. Margaret Tremwel, MD, a stroke neurologist with Sparks Health System based in Fort Smith, flew in by helicopter and gave a ball to Lt. Gov. Mark Darr, who threw out the first pitch.

Sparks was designated as a primary stroke center in 2005 by the Joint Committee on Accreditation of Hospitals and the American Heart Association. Sparks was then the 11^th hospital in the country to get that designation that represents excellence in reducing stroke mortality and morbidity rates.

“If you go to a stroke center, you are more likely to have a good outcome than not,” Tremwel said. “At Sparks, our mortality rate and lengths of stay have decreased dramatically. That is what has made us in the top two percent of stroke hospitals in the nation. And with Arkansas SAVES, we have telemedicine to bring all our state hospitals up to the same level of care.”

Arkansas has a high incidence of stroke and is number one in the country in stroke mortality. Tremwel would like to see the state improve by having a population more aware of stroke prevention. Although there is some genetic predisposition to stroke, most of the biggest risk factors are under the control of individuals.

The risk factors include smoking, being overweight or obese, high blood pressure, high blood sugar and high cholesterol.

“We have an epidemic in the U.S. with high blood pressure,” Tremwel said. “The government has released new guidelines recommending salt intake should be less than 1.5 grams per day. You can’t meet that eating fast food and processed food because it is high in sodium.”

There is concern that as baby boomers enter their geriatric years, the rates of stroke could skyrocket if measures aren’t taken to address the risk factors. But you don’t have to be over 50 to be at risk for stroke.

“My youngest stroke patient was 25 and he died,” Tremwel said. “It was traditional risk factors. Prevention is the most important thing to do. Next, know the signs and symptoms of stroke: Weakness, heaviness or numbness on one side of the body or other; the sudden onset of confusion; loss of language; loss of vision in one or both eyes; the sudden onset of dizziness; the tendency to fall to one side; and last, the worst headache of your life.

“If any occur dial 911. Rural hospitals and their EMS systems participating in the Arkansas SAVES program are well versed in recognizing stroke in the field, and will get you to an appropriate place for stroke treatment. When a stroke patient arrives at a SAVES hospital, they are evaluated by the ER physician. If they are diagnosed with a stroke having occurred within the previous 4.5 hours, the hospital will call the SAVES call center and be rapidly connected by video and audio equipment to a stroke specialist. If a diagnosis of acute stroke is made and if the patient is a candidate for tPA, it can be administered at the local hospital ER. Local ER staff, working under the direction of the stroke specialist, provide this treatment rapidly and safely.”

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