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Working to Improve Stroke Response & Speed Care

CHICAGO -- When time is of the essence, State Representative Bob Biggins (R-Elmhurst) says seconds really do count.

"Time loss really is brain loss when it comes to stroke," says Biggins, 62, who knows firsthand just how important those first minutes and hours can be. The representative, who has served the 41st District since 1993, suffered a stroke walking outside the County Building in downtown Chicago and now works legislatively to improve statewide stroke care.

As a stroke survivor, Biggins is a key sponsor of recent legislative efforts to create a system of primary stroke centers throughout the state and was recognized for his efforts this fall with the Legislative Lifesaver Award presented by the American Stroke Association, a division of the American Heart Association.

Biggins legislative efforts and ongoing work includes development of a bill that could significantly improve emergency response and medical treatment for stroke victims in Illinois, says Mark Peysakhovich, senior director of advocacy for the American Heart Association/ American Stroke Association.

"The more we can speed up the time it takes to diagnose and treat a stroke, the better potential outcomes," Peysakhovich says. "Representative Biggins was fortunate to quickly receive excellent care and we re grateful he s committed to ensuring that every other patient with a potential stroke receives the same kind of fast, quality care, saving lives and reducing or preventing permanent disability related to stroke."

Taking steps to improve the system

According to the experts, stroke is the third-leading cause of death in the United States and a leading cause of serious long-term disability.

Peysakhovich and Biggins say building consensus around potential state recognition of primary stroke centers is an important step to restructuring and significantly improving the overall system of care.

"Studies show that stroke patients are less likely to die or require long-term institutional care when an integrated system approach to stroke care is used," Peysakhovich reports.

Biggins, who was immediately transported to Northwestern Memorial Hospital by paramedics following his stroke, says the rush to care and immediate access to specialized stroke care helped mitigate any long-term disability in his case.

"I don t remember much of the actual incident," admits the father of two and grandfather to seven. "However, I do know that following the event, I had difficulty walking and other movement problems. I wasn t in a strong mental state and everyone tells me I was a very compliant patient."

He credits early intervention and his multidisciplinary medical team both at Northwestern and Elmhurst Memorial where he later transferred, for saving his life and eventual return to his normal schedule. Others, he says, aren t so lucky.

Biggins points to the experience of colleagues in the House who also suffered strokes. Neither received care in a hospital equipped to speed stroke care and neither have been able to regain skills and return to work.

"By bringing together ambulance providers, hospital representatives, fire departments, other care providers and stakeholders, we hope to build consensus for this landmark legislation to create a primary stroke system," he reports. "Immediacy of care is vital and so is getting patients to the right place as quickly as possible."

Education and prevention are key

Public education and primary prevention, notification and response of emergency medical services, acute stroke treatment including hyper-acute and emergency department treatment, subacute stroke treatment, secondary prevention and rehabilitation all are addressed in a comprehensive House Bill first introduced at the beginning of the 2008 session of the Illinois General Assembly.

Amazing advances in stroke diagnosis and care, along with exciting stroke interventions are good news for patients, but only if received within a few hours of symptom onset, says Kathleen Grady, Ph.D., clinical nurse specialist and administrative director of the Center for Heart Failure at Northwestern Memorial Hospital s Bluhm Cardiovascular Institute and a member of board of directors of the American Heart Association,

It used to be that very little could be done, says Dr. Grady, who chairs the American Heart Association Illinois Advocacy Committee. When a stroke happened, she notes, you d simply have to wait it out. That s not the case anymore.

Today s advances in care mean the ability to mitigate life-threatening bleeding on the brain, bust clogs and reseal leaks.

"Tissue plasminogen activator (tPA), a clot-busting drug, now acts like Draino for the human body, and can reduce the amount of damage to the brain and save lives," she explains. "However, to be effective, tPA must be given within a few hours after symptoms begin.

Administering tPA or other clot-dissolving agents is complex and is done through an intravenous line in the arm by hospital personnel."

For patients who seek medical assistance within six to eight hours after a stroke, other options such as an intra-arterial retrieval device now exist. A special FDA-approved Mechanical Embolus Removal in Cerebral Ischemia retrieval system device is guided directly to the clot and mechanically removes clots in a matter of minutes.

The devices closely resemble a delicate corkscrew held in a catheter tip. That tip shields the corkscrew from the artery wall until it is twisted into the clot. Then the device and clot are withdrawn from the artery similar to uncorking a bottle of wine.

"But all these things must be done quickly to save lives and brains," Dr. Grady states.

"Legislation could significantly change our current emergency response system which calls for paramedics to transport patients to the nearest hospital. Instead, patients exhibiting strokelike symptoms would be transported to a state-recognized primacy stroke center where urgent lifesaving care could be provided. That could mean good news for everyone."

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