While researching statistics related to the ongoing access issue for mechanical thrombectomy treatment for large vessel occlusion stroke, I found information that estimated the current number of Baby Boomers in the 73 million range. And, while certainly the 2020 census will further refine that number to show the impact of this generation on America’s age structure, this is a rather foreboding thought…
We already know that 75% of strokes occur in people over 65, and by 2030, all Baby Boomers will cross that age threshold. What will our total stroke rates look like here in the US? Will our healthcare system and programmatic infrastructure be ready to handle what is likely to be a significant increase in not only stroke incidence, but also patient volume to an already overwhelmed clinical specialty in many areas of the country?
As a result of this, hospitals need to plan now for the influx of stroke patients that is sure to come in the near-term future. The need for more thrombectomy-capable centers grows more urgent every day. The difference in outcomes between standard medical treatment (including tPA) and the use of mechanical thrombectomy (MT) is vastly different. For instance, for every 100 patients treated with MT, approximately 40 will have a less-disabled outcome and an additional 23 will achieve an independent outcome.
With such limited access to mechanical thrombectomy as is the case now, consider what this might mean in terms of elderly patients living with the severe disabilities as the result of stroke. And then consider how we as a society will be able to handle the financial burdens this might represent. For patients discharged with stroke-related disabilities, the expense is nearly double that of a non-disabled person (estimated $120,753 vs $54,580, respectively).
We also know that approximately 90% of stroke deaths are caused by large vessel occlusions and approximately 60% of post-stroke dependency. So, putting aside the monetary issues, the more important aspect is the humanitarian or ethical considerations. Knowing we have the knowledge and capability to offer this life-saving and life-altering treatment, how can we as a medical community not be working our hardest to ensure this procedure is widely available to patients in all areas of the country?
It is not enough to say we have comprehensive stroke centers and we can transfer patients once we identify a large vessel occlusion. There are two flaws in this thought process:
First, triage caregivers do not always focus on identifying large vessel occlusions (LVOs) in centers without thrombectomy capability. A recent client of ours felt confident in identifying LVOs and getting those patients to the comprehensive stroke center, but that Center is 90 minutes away, which requires transport by helicopter flight. They were identifying 1 to 2 patients per month. Following implementation of a mechanical thrombectomy service, with the heightened awareness of the signs and symptoms of LVO, the client is now averaging 6 to 7 per month, which can now stay for care at their organization instead of being taken elsewhere.
The second flaw is the transfer process itself, which often takes way too long, which results in worse outcomes. If a comprehensive stroke center or thrombectomy-capable center is within a reasonable distance (typically defined as ≤30 minutes in an urban area or ≤50 minutes in a rural area), patients should be taken directly there from the field to improve outcomes. Certain states have initiated “bypass” laws that regulate emergency transport in such a way. But, in many areas of the country, a comprehensive stroke center or thrombectomy-capable center isn’t available within a reasonable distance. Without access to this care, EMS must take patients directly to a center that’s ultimately not capable of providing the right care at the right time. Transfers cause delays and outcomes suffer, an issue compounded with the fact that there aren’t centers to transfer patients TO in many areas.
Based on client data and information, Corazon research, industry trends, and the expertise that our team of Service Line Experts has gained in over 20 years in business proves that we simply need more thrombectomy-capable stroke centers to provide access to all Americans. This may seem to be a daunting task, but with the right planning and analysis, any organization can evaluate the potential for offering thrombectomy and then work to lay the foundation necessary to advance stroke care…
As a revenue-generator, market differentiator, and forward-thinking strategy, thrombectomy has many growth benefits. But the potential for saving lives and decreasing the level of disability for those who suffer from stroke makes thrombectomy a worthwhile offering to consider. Corazon can help your organization determine growth opportunities in stroke care, while evaluating the business case for this much-needed clinical offering.
You can start with our Thrombectomy Calculator…