"More widespread deployment of mobile stroke units may have a major public health impact on reducing disability from stroke," lead researcher Dr. James Grotta, director of stroke research at the Clinical Institute for Research and Innovation at Memorial Hermann - Texas Medical Center in Houston, said in statement from the American Stroke Association International Stroke Conference (ISC) 2021, where he presented the data.
Mobile stroke units are equipped to diagnose and treat acute ischemic stroke quickly before arrival at the hospital, including giving clot-busting tissue plasminogen activator (tPA).
In a late-breaking science session at ISC 2021, Dr. Grotta reported data from the ongoing BEST-MSU study for 1,047 adults with ischemic stroke and eligible for tissue plasminogen activator (tPA) who were treated at seven U.S. centers between 2014 and 2020.
The researchers compared outcomes of 617 stroke patients treated in a mobile stroke unit with those of 430 stroke patients cared for by EMS in a standard ambulance.
Compared to regular EMS care, patients treated in a mobile stroke unit received a clot-dissolving drug more often, more promptly and with less likelihood of stroke-related disabilities, Dr. Grotta reported.
Overall, 97% of patients transported in a mobile stroke unit received tPA compared to 80% of those brought to the ED by standard ambulance. One-third of the patients treated by a mobile stroke unit were treated within one hour of symptom onset, compared to only 3% of their peers transported by a standard ambulance.
After three months, 53% of the patients treated in mobile stroke units achieved full recovery, compared to 43% of the patients treated in a standard ambulance.
"Putting this in perspective, if you treated 100 patients with a mobile stroke unit rather than with standard management, 27 will have less final disability and 11 more will be disability free achieving a Rankin score of zero to one," Dr. Grotta said during a media briefing.
Dr. Grotta and his colleagues are now studying the cost-effectiveness of mobile stroke units.
"Depending on how much bells and whistles you want on it and how many shifts you're going to run," these units cost anywhere from $1 to $2 million, he told the briefing.
"Conservatively," mobile stroke could save a million dollars of healthcare costs a year, "so I'm pretty sure that, given the clinical results we see, that it's going to be cost-effective, but we just have to wait and see," he said.
"The important thing is that mobile stroke units need to be reimbursed," he said. But for now, that's a problem, according to related research presented at the conference.
A team led by Dr. Kenneth Reichenbach, program director of the Mobile Stroke Unit at Lehigh Valley Health Network in Allentown, Pennsylvania, surveyed 19 of the 20 mobile stroke unit programs in the United States about reimbursement.
Eighteen reported a negative financial status. The one outlier that reported a positive financial status was classified as an outpatient clinic and not an ambulance. All mobile stroke programs relied at least partly on funding from personal gifts, grants or institutional support because of billing restrictions from healthcare insurers, Dr. Reichenbach reported.
"If mobile stroke units cannot be reimbursed for the important care they provide, this vital service will be lost unless private donors are willing to continually step up to support these programs," Dr. Reichenbach said in a statement.
"We need overwhelming, united support for this to change within federal entities including the Centers for Medicare and Medicaid Services to explore appropriate pathways for Medicare reimbursement for the full range of advanced mobile stroke unit services," he added.
Dr. Mitchell Elkind, president of the American Heart Association (AHA), said that given the demonstrated benefits of mobile stroke units, "we now have to show that we can do this in a cost-effective manner and in a way that it can be useful across the country."
"So far, these units are largely confined to just a few regions around the country. Most are in metropolitan regions, some are in more rural areas, but there's a limited number of them. There are only 20 of them around the country, and obviously we have to have many more if they're going to have a big impact on care. And we have to find a way to pay for them because they are not cheap to run and to operate," Dr. Elkind told the conference.
SOURCE: https://bit.ly/3raytwu American Stroke Association International Stroke Conference (ISC) 2021, March 17-19, 2021.
By Megan Brooks
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