Strokes, often referred to as cerebrovascular attacks, occur when a portion of the brain does not receive ample blood supply. This can occur due to occlusion or rupture of a vessel that supplies the brain with oxygen-rich blood. Strokes caused by blockage, or occlusion, are referred to as ischemic in nature. While strokes caused by the rupturing of vessels are labelled hemorhagic¹. Whatever the cause, decreased blood supply to the brain can cause significant effects. Depending on the location of the stroke, effects include localized paralysis, speech and language problems, changes in behavior, memory loss, vision problems, or even a state of paralysis. Rapid detection, diagnosis, and reperfusion of the brain can help prevent permanent damage². Stroke is currently the number 5 cause of death and the leading cause of disability in the United States

Stroke mortality rate includes all Arkansans that died directly a a result of a stroke, whether hemorrhagic or ischemic. This rate is presented as deaths per 100,000 Arkansans and was derived from the Center for Disease Control. It is a simple yet powerful indication as to the magnitude of the problem that stroke presents in addition to the effectiveness of Arkansas's management of patients experiencing a stroke. This rate is compared to the national average for the same period of time.  Unfortunately, the Arkansas mortality rate has experienced a steady increase since 2014 which is also mirrored in the national data. However, the Arkansas rate is increasing at a greater rate per year and was most recently 15.3 per 100,000 when compared to 10.4 per 100,000 nationally. 

Source: ¹ About Stroke. Retrieved April 1,2018 from https://www.strokeassociation.org/en/about-stroke

Source: ² Effects of Stroke. Retrieved April 1,2018 from https://www.strokeassociation.org/en/about-stroke/effects-of-stroke

• Acute Stroke Care Task Force
• American College of Cardiology 
• Arkansas Department of Health Tobacco Cessation and Prevention Branch 
• Arkansas Department of Health Trauma Branch – Stroke and STEMI Section 
• Arkansas Department of Health Chronic Disease Branch 
• Heart Disease and Stroke Prevention Coalition 
• Mercy Telestroke System 
• UAMS Center for Distance Health - AR SAVES (Arkansas Stroke Assistance through Virtual Emergency Support)

Acute stroke mortality rates are affected by incidence of stroke, stroke literacy, prehospital recognition and proper triage, and hospital protocol provider literacy¹. Reducing the incidence of acute stroke in Arkansas requires a multi-faceted approach. Reducing risk factors is a pillar of prevention.  Male gender, advanced age, family history, and African American or Hispanic ethnicity are all non-modifiable risk factors of stroke. However, hypertension, smoking, diabetes, cholesterol imbalance, and physical inactivity or obesity are all modifiable risk factors that can be targeted to reduce the risk of acute stroke².

Stroke literacy is important in identifying when an individual is having a stroke. There have been national efforts to address the low stroke literacy that is common across the country. One is the Act FAST campaign which educates the public as to the signs and symptoms of stroke. The letters in FAST correspond to facial droop, arm drifting when raised, slurred speech, and time which reinforces the importance of seeking medical attention quickly. Public education campaigns such as these have been shown to be effective in increasing health literacy³.

Prehospital recognition, proper triage, and hospital provider literacy are all addressed in this scorecard through various metrics. Mortality rates should demonstrate improvement in these metrics based on current evidence. 

Source:¹ Ramirez L, Kim-Tenser MA, Sanossian N, et al. Trends in Acute Ischemic Stroke Hospitalizations in the United States. J Am Heart Assoc. 2016;5(5):e003233. Published 2016 May 11. doi:10.1161/JAHA.116.003233

Source: ² Brain Basics: Preventing Stroke. Accessed from: https://www.ninds.nih.gov/Disorders/Patient-Caregiver-Education/Preventing-Stroke

Source: ³ Phan Vo, Lucy et al. Impact of the Act FAST stroke campaign delivered by student pharmacists on the primary prevention of stroke. Journal of the American Pharmacists Association , Volume 57 , Issue 3 , 326 - 332.e6

The Arkansas Department of Health has implemented quality improvement iniatives that will address strokes in Arkansas, including hospitalization rate. First of all the Arkansas Department of Health has a Chronic Disease Council which has been created to address hypertension, diabetes, obesity, and other chronic diseases that are a significant burden for Arkansans. Many of these chronic diseases are important risk factors for stroke. Decreasing the incidence and prevalence of such chronic diseases will put fewer Arkansans at risk of acute stroke in the future. 

Additionally, there are efforts that have been iniataed that target hospital arrivals by EMS, % door to CT,  time to thrombolytic therapy, IV rt-tpA time, and percent defect free care. Thes metrics, that will be discussed later in the scorecard, will all influence both hospitalization rates and mortality rates.