Ischemic Stroke - Hennepin County Medical Center

Profiles in Critical Care
You are the Executive Director of the
Minnesota Stroke Initiative. What is
this initiative?
The Minnesota Stroke Initiative is one of the
largest stroke initiatives in the United States.
There are three components. The first is education.
Through the initiative, we’ve worked
with several media sources like the American
Heart Association (AHA) to provide educational
materials in different forms to the public. The
second aspect is clinical services and training.
Clinical services include endovascular treatment,
neurocritical care, stroke units, and
stroke clinics. In terms of training, we now
have one of the largest training programs in
the United States in the subspecialties of
stroke. A third very important component is
research. We work with the National Institutes
of Health (NIH) on research on the epidemiology
of stroke, which will help identify new risk
factors and methods of prevention. We also
work with NIH and AHA to do clinical and basic
research, developing new therapies for stroke.
“It’s true that people don’t come to the
hospital in time, but also hospitals don’t
react to the need on time...recent
studies have shed light on those deficits
in the medical system, so we can’t just
say it’s about patients not getting to the
hospital on time.”
When it comes to stroke care, what does
Minnesota do well? What could we do better?
Minnesota now has more specialized stroke
centers than we used to have. Also, while in
the past there was somewhat of a shortage of
teaching programs that provide specialized
stroke care, now there’s been a realization that
we need to keep up with the rest of the country.
As a program [at Hennepin County Medical
Center and the University of Minnesota
Medical Center, Fairview], we now would be
rated in the top ten in the country, and that
comes from having some of the largest training
programs and clinical programs.
As a state, we need to do more work on public
education. We haven’t done as well as states
like Florida, New Jersey, and Massachusetts.
Those states also have defined standards of
what they want to see in comprehensive and
primary stroke centers, and here we have none
of that. It’s a matter of funding at a state level,
and the state getting behind it legislatively.
In twenty years, what will stroke care in
Minnesota look like?
There will be evolution in three frontiers:
First, evolution in patients recognizing a stroke
earlier and coming to the hospital in time.
Right now, we still have a lack of public recognition
of what a stroke feels like, that stroke is
treatable, and you need to go to the hospital
as soon as possible and not wait until the
next morning.
Second, prevention. We will see programs trying
to detect high-risk groups in the population
and finding interventions that can target those
groups and yield the best results.
Third, treatment. There will be new treatments
and the treatments will be applicable to a
broader population. Right now, we have treatments
only offered to 4% of the population. It’s
true that people don’t come to the hospital in
time, but also hospitals don’t react to the need
on time. Hospitals aren’t currently ready to
react in an expedient way, 24 hours per day.
Recent studies have shed light on those deficits
in the medical system, so we can’t just say
it’s about patients not getting to the hospital
on time.
12 | Approaches in Critical Care | December 2008