Did you know that the stroke burden in India is estimated to be more than 1.5 million per year, out of which 70%–80% are ischemic, with nearly 1 stroke every 40 seconds and stroke related-death every 4 minutes! Shocking isn’t it! As per the Indian Stroke Association (ISA) 2018, strokes are the second most leading cause of death in India and the cases have risen by 17.5% over the last 15 years. At this backdrop, there’s a pressing need for developing proper stroke care systems by utilizing Telestroke services to provide improved and timely care to patients across the country. Especially, when it comes to rural areas where access to good and advanced treatment options are limited, Telestroke management could be a boon. Before we look at the options of bridging the significant gap that currently exists in stroke care, let’s understand what it means along with its applications.
What Is Telestroke? What does the Telestroke network comprise of?
Telestroke is a web-based approach for treating stroke patients by the electronic transfer of data (such as imaging and signs) with a special camera and microphones to facilitate communication between any two locations. It allows a neurologist to examine a patient at another hospital that may be miles away and to treat through thrombolysis by communicating with the onsite physician available with the patient. This is done with the use of real-time audio-visual technology that may help in improving outcomes in patients receiving this life-saving treatment at the right time. The Telestroke model provides the foundation for collaborative, inter-professional care and augments local services that are not immediately available. How – by leveraging remote expertise, resources, and the standardization of processes. As ‘time-loss could lead to brain-loss! ‘
In India, the first Telestroke hub and spoke model was used (using WhatsApp) within tertiary care hospitals in Himachal Pradesh, as a hub (with neurologist) and district hospitals as spokes (without neurologists). The neurologists in district hospitals were trained for stroke treatment and the ‘tissue plasminogen activator (tPA)’ was made available at all these centres free of cost through hospital pharmacies. Neurologists at 2 tertiary care centres were made available for consultation over phones. Around 26 patients had received thrombolysis treatment through Telestroke and only two patients developed an intracranial bleed following thrombolysis, and both were nonfatal.
Types of Stroke
There are mainly 3 types of stroke: transient ischemic attack (mini-stroke), ischemic stroke, and haemorrhagic stroke. Almost 87% of acute strokes are ischemic and the treatment/recovery depend upon the type of stroke one has. Time is the most important factor for treating a stroke patient as those who are treated within 90 minutes of a stroke have a significantly lower risk of permanent brain damage or death. Acute stroke is a time-sensitive condition, and in most of the cases, the therapeutic window for thrombolytic therapy (tPA) is less than 4.5 hrs. for it to be effective.
How does it work?
“I can examine someone very interactively with the help of a physician or a nurse on the other end and I can decide of the stroke severity and the type of stroke by looking at the patient and the brain image, it’s almost like being in the room.”
These words Dr Schwamm, a neurologist from Massachusetts General Hospital, states the effectiveness of Telestroke in treating stroke patients who are not in the proximity of stroke patients or available ‘in-person’ for urgent care.
In a Telestroke consultation, if your primary physician suspects acute stroke symptoms, he/she will activate the stroke telemedicine hotline at the distant hospital; experts are often on call 24/7. The distant site’s on-call doctor usually responds within minutes. The neurologist at the distant site performs a live, real-time audio/video consultation, evaluates the patient’s test results and, works with your physician to determine the most appropriate treatment option. The neurologist also sends the treatment recommendation electronically to the hospital where the patient is being monitored.
What’s crucial for better outcomes – identifying, addressing and monitoring progress at all stages of the consultation and post it as well.
Benefits of Telestroke
The goal of a Telestroke consultation is to maximize a patient’s recovery (reducing brain damage) by making an accurate diagnosis, determining eligibility for short-term therapy, and delivering the chosen treatment. Besides this, other benefits of Telestroke are:
- Lower healthcare costs
- 24/7 service so emergent/non-emergent patients are catered to
- Treatment options such as clot-busting drugs can be administered sooner
- Helps in reducing the risk for stroke-related disability
- Allows on-going expert treatment at the patient’s local hospital and reduces the necessity for patients to transfer to a different hospital
- Remote access to multiple healthcare facilities so more patients are addressed on time
COVID and remote health monitoring
The COVID-19 outbreak has made remote monitoring the new normal and it looks like a trend that is here to stay, with or without the pandemic.
A recent case of a 75 years old patient from the rural community may support this claim. Within 40 minutes of his stroke onset, distinct symptoms such as a facial droop, weakness, and numbness of the right arm, slurred speech were seen. Thanks to Telestroke care, on connecting with a neurologist through a video call, the physician addressing him was able to administer TPA after exclusion of haemorrhage within 3 hours. Saved his life and brain damage too! Since the pandemic imposes movement restrictions, the consulting neurologist, without any interruption was able to monitor his actions on a daily basis and was able to obtain a more accurate reading of his conditions.
A stroke survivor’s struggle with performing basic activities might be tough but knowing that you have a doctor to consult anytime can give you ample peace of mind.
Future and Conclusion
The primary aspect of connecting patients with the team of experts for recommended stroke treatment through Telestroke can be achieved in India only if thrombolysis and imaging techniques are made available at all levels of health care. Whereas, keeping in mind India’s flourishing technological sector and leading communication networks, Telestroke is not only useful for emergency cases but also in the pre-hospital ambulance setting, rehabilitation, the medical care unit, and outpatient stroke prevention clinics. This also means that bridging the gap between the neurologists and patients that is currently 1: 5 lakhs can be addressed. Telestroke care can improve the recovery of more patients along with lessening the percentage of negative outcomes that currently occur.
Various healthcare facilities are making efforts to enhance quality and offerings of healthcare provided within the rural areas through Telestroke to a level comparable with the urban areas. The ultimate idea is to decrease mortality and morbidity rate of stroke and improve stroke care in India as it’s always about patient care!