Historical collection · First published Dec 12, 2024; added to EM Weekly Oct 28, 2026. This retrospective summary may be superseded by later evidence or guidance.
← All articlesIdentifying Best Practices for Improving the Evaluation and Management of Stroke in Rural Lower-Resourced Settings: A Scientific Statement From the American Heart Association
Summary
This AHA scientific statement addresses acute stroke care in rural and lower-resourced settings, where many patients initially present to community EDs without stroke-center resources. It recommends system-level strategies including written stroke protocols, telestroke access, rapid imaging transfer, hub-and-spoke mentorship, standardized transfer pathways, quality-improvement participation, and efforts to shorten door-in-door-out time for thrombectomy candidates. It also supports geographically efficient expansion of Acute Stroke Ready Hospital and Primary Stroke Center capability.
Why it matters
For community and rural EDs, the practical message is to build stroke capability before the patient arrives: standardized protocols, immediate telestroke access, rapid CTA/image sharing, parallel transfer activation, and explicit relationships with receiving stroke centers. The statement changes systems planning more than bedside drug selection.
Study at a glance
- Design
- Consensus statement
- Population
- Patients with suspected or confirmed stroke presenting to rural or lower-resourced US EMS systems, emergency departments, hospitals, and transfer networks.
- Sample size
- Not applicable
- Intervention
- System-level strategies to improve rural acute stroke access and performance, including stroke-center readiness, telestroke, standardized protocols, rapid imaging and transfer, hub mentorship, and quality improvement.
- Comparator
- Existing heterogeneous rural stroke systems and resource availability; the statement itself is not a comparative trial.
- Primary endpoint
- Critical appraisal and consensus strategies for improving acute stroke evaluation, treatment access, transfer, and quality in rural lower-resourced settings.
Main findings
- The statement identifies remote community EDs as anchors of the rural stroke chain of survival and emphasizes written protocols, simulation, telestroke, and stronger hub relationships.
- For transfer-dependent thrombectomy care, it supports rapid vascular imaging, early parallel engagement of tertiary centers, image sharing, established transfer agreements, and door-in-door-out optimization.
- Expansion of Acute Stroke Ready Hospital and Primary Stroke Center certification, better EMS/routing infrastructure, data integration, and quality-improvement participation are proposed to reduce rural disparities.
Limitations
This is a systems-of-care scientific statement built largely from observational evidence, quality-improvement data, and expert consensus rather than randomized comparisons of the proposed system interventions. Feasibility depends heavily on local staffing, transport, imaging, telehealth, and regional resources.
Recommendation strength
American Heart Association scientific statement based on critical appraisal and expert consensus; it is not a single uniformly GRADE-rated recommendation set.
Read the primary source
Full text: Open-access full text available.
Original sourceDOI: 10.1161/STR.0000000000000478
PMID: 39665145
Material reviewed: full text.
Source retrieved Oct 28, 2026. Historical backfill. PubMed verifies Epub 2024-12-12, PMID 39665145, and DOI 10.1161/STR.0000000000000478; the official AHA summary and open full text were reviewed. A targeted correction/retraction search did not identify a correction or retraction. This is systems-level historical guidance; later 2026 AHA/ASA acute ischemic stroke guidance should govern current disease-specific treatment recommendations.
Corrections & review history
No corrections recorded. Human review: not yet human-reviewed.