Abstract
Stroke is a leading cause of adult disability and the fourth leading cause of death
in Canada. Most strokes are ischemic and functional outcome is highly time-dependent,
making fast diagnosis and treatment initiation crucial. This poses a challenge in
vast geographical areas where stroke neurology expertise is only available in urban
centres. In this article we review the rationale for telestroke networks and their
current implementation in Canada. Telestroke networks enable stroke-specific procedures
to be performed by less experienced physicians under the guidance of stroke neurology
experts. We also present evidence that the safety and effectiveness of intravenous
alteplase in community hospitals in a telestroke network seems to be comparable with
that achieved in dedicated stroke centres. It is thus a viable option to guarantee
an aging population access to stroke care across large geographic regions with faster
treatment and access to more advanced treatment options by means of transfer to a
comprehensive centre if necessary. Although telestroke networks have an upfront implementation
cost, they can lead to reduced direct and indirect costs for the health care system
by reducing days spent in the hospital as well as disability with the need for long-term
care. Telestroke networks can also be used for identification and enrollment of patients
into emergency stroke trials and thus provide a more representative sample of the
population and increase recruitment. Standardization of regional telestroke networks
could lead to collaborations with larger data acquisitions for research purposes and
quality control in the future.
Résumé
Les accidents vasculaires cérébraux (AVC) constituent la première cause d’invalidité
chez les adultes et la quatrième cause de mortalité au Canada. La plupart des AVC
sont ischémiques et le pronostic fonctionnel repose grandement sur le temps; c’est
pourquoi la rapidité est cruciale dans l’établissement du diagnostic et l’instauration
d’un traitement. Cela représente un problème dans les vastes régions géographiques
où l’on trouve l’expertise en neurologie des AVC seulement dans les centres urbains.
Dans cet article, nous analysons la raison d’être des réseaux de Télé-AVC et de leur
implantation actuelle au Canada. Les réseaux de télémédecine pour les AVC permettent
à des médecins peu expérimentés de prodiguer des soins spécifiques des AVC sous les
directives de neurologues experts dans le domaine. Nous présentons également des données
probantes indiquant que l’innocuité et l’efficacité de l’altéplase administrée par
voie intraveineuse dans un hôpital communautaire avec l’aide du réseau de Télé-AVC
semblent comparables à ce qui est observé dans les centres spécialisés en AVC. Il
s’agit donc d’une option viable pour garantir un traitement rapide de l’AVC aux populations
vieillissantes vivant dans des régions éloignées ainsi qu’un accès à des options thérapeutiques
avancées grâce au transport du patient vers un centre complètement équipé au besoin.
Bien que la mise en place des réseaux de Télé-AVC génère des coûts initiaux, ces réseaux
peuvent entraîner une diminution des coûts directs et indirects pour le système de
santé en réduisant les journées d’hospitalisation ainsi que l’invalidité nécessitant
des soins à long terme. Les réseaux de Télé-AVC peuvent également servir à trouver
et à recruter des patients pour des essais sur les AVC aigus et ainsi créer un échantillon
représentatif de la population et augmenter le recrutement. La normalisation de réseaux
régionaux de Télé-AVC pourrait mener à des collaborations permettant l’acquisition
d’une grande quantité de données destinées à la recherche et au contrôle de la qualité
à l’avenir.
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Article info
Publication history
Published online: December 27, 2017
Accepted:
December 17,
2017
Received:
October 31,
2017
Footnotes
See page 895 for disclosure information.
Identification
Copyright
© 2018 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.
