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CDC State Heart Disease and Stroke Prevention Programs

Paul Coverdell National Acute Stroke Registry logo

  • Stroke kills almost 130,000 of the 800,000 Americans who die of cardiovascular disease each year—that’s 1 out of every 19 deaths from all causes.
  • More than 795,000 people have a stroke each year in the United States.
    • 610,000 of those are first or new strokes.
    • 185,000 or nearly 1 of 4 are recurrent strokes.
  • About 25% die at the time of the stroke event or soon after.
  • 15%–30% remain permanently disabled and their families live with the disabling effects of stroke.
  • Total annual stroke costs to the nation are about $38.6 billion.
  • Transport of stroke patients to the hospital results in faster treatment, yet one-third of stroke patients do not call 9-1-1 and use EMS to get to the hospital.
  • Gaps remain in the quality of care provided to acute stroke patients.

Mission and Description

The CDC was directed by the U.S. Congress in 2001 to implement state-based registries to measure and track acute stroke care to improve the quality of that care. Congress also named this the Paul Coverdell National Acute Stroke Registry (PCNASR) in memory of Senator Paul Coverdell of Georgia, who died of a stroke in 2000 while serving in the U.S. Congress.

Following an initial 3-year pilot phase, CDC has provided funding and technical assistance to states to develop, implement, and enhance systems for collecting data on patients experiencing an acute stroke, to help analyze these data, and to use those results to guide quality improvement interventions for acute stroke care. From 2005 through mid-2012, more than 250,000 patients benefitted from hospital participation in the PCNASR.

The mission of the PCNASR is—

  • Measure, track, and improve the quality of care and access to care for stroke patients from onset of stroke symptoms through rehabilitation and recovery.
  • Decrease rate of premature death and disability from stroke.
  • Eliminate disparities in care.
  • Support development of stroke systems of care that emphasize quality of care.
  • Improve access to rehabilitation and opportunities for recovery after stroke.
  • Increase the workforce capacity and scientific knowledge of stroke care within stroke systems of care.

The near-term goals of the PCNASR are to—

  • Encourage the development of statewide systems of care for stroke patients through coordination with emergency medical services and collaboration among statewide partners.
  • Communicate with major stakeholders in stroke care to ensure ongoing improvement in the quality of that care.

The long-term goal of this program is to ensure that all Americans receive the highest quality of acute stroke care currently available and to reduce the number of untimely deaths attributable to stroke, prevent stroke-related disability, and prevent stroke patients from suffering recurrent strokes.


Current Activities

The Components of a Stroke System of Care1


Components of the stroke care system. These are Pre-Event: Primordial prevention and community education; and Primary prevention and outpatient care. Event: EMS; Acute care; Rehabilitation and recovery; and telemedicine for stroke. Post-Event: Ongoing secondary prevention.

As of July 1, 2012, CDC is funding 11 states through cooperative agreement, CDC-RFA-DP12-1203 [PDF-662K], Paul Coverdell National Acute Stroke Program, to meet the mission of the PCNASR. This cooperative agreement is for a 3-year period, pending availability of funds.

Funded states are working on improving the care given to patients experiencing a stroke from the onset of stroke symptoms. States will be working with emergency medical services (EMS) agencies to improve EMS care for suspected cases of stroke, the transition from EMS to hospital care, hospital care, and the transition from hospital to the next care setting. Depending on what component the state is funded for, they are required to evaluate the effectiveness of implemented in-hospital and EMS QI interventions and transition from EMS to hospital; and transition of care (TOC) protocols from hospital to TOC systems (e.g. long term care facility, rehabilitation center, primary care provider, etc.).

CDC’s PCNASR has a long history of working collaboratively with the Joint Commission and the American Heart/Stroke Associations to provide the best quality care for acute stroke patients.

Additionally, the CDC and American Heart Association (AHA) have a Memorandum of Understanding (MOU) in place to further enhance our joint work to improve the quality of care for stroke patients across multiple settings. Learn more about this MOU.

Learn more about the history and evolution of the PCNASR.


Publications

Journal Articles

  • George MG, Tong X, Yoon PW. Use of a registry to improve acute stroke care—seven states, 2005–2009. MMWR. 2011;60(07);206-210.
  • George MG, Tong X, McGruder H, et al. Paul Coverdell National Acute Stroke Registry surveillance—four states, 2005–2007. MMWR. 2009;58(SS07);1-23.
  • Frankel M, Hinchey J, Schwamm LH, et al. Pre-hospital and hospital delays after stroke onset—United States, 2005–2006. MMWR. 2007;56(19):474-478.

PCNASR Bibliography [PDF-336K]

Paul Coverdell National Acute Stroke Registry—Strategies from the FieldStrategies from the Field cover.

Each Coverdell-funded state has identified unique ways to meet the goals and objectives of the Coverdell program. This document outlines creative approaches developed by states and highlights lessons learned. These strategies from the field are intended to illustrate the ways in which Coverdell states are addressing stroke care. The information can be used by Coverdell-funded states as well as states that are not funded by Coverdell but are interested in implementing a stroke registry.



Related Links


Additional Resources

Paul Coverdell National Acute Stroke Registry Infoshare Conference Call on Stroke Coding Issues, with Barry Libman (May 21, 2009, 10:00–11:00 am ET).

Topic: Coders and other medical professionals requiring an understanding of the rules specific to the coding of stroke care will benefit from this presentation discussing—

  • How coding captures an episode of medical care.
  • Coding rules and guidance that determine the reporting of diagnoses.
  • Coding rules specific to stroke.
  • Present on admission indicators.
  • The future of coding: ICD-10-CM/PCS.

Listen to the call[MP3–8M] or access the written transcript [Word–81K].


Reference

  1. Adapted from LH Schwamm, et al. Recommendations for the Establishment of Stroke Systems of Care: Recommendations from the American Stroke Association’s Task Force on the Development of Stroke Systems. Stroke. 2005;36:690-703.

 
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