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CDC State Heart Disease and Stroke Prevention Programs


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. Of those:

  • 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. In 2012, as the registry expanded to include more activities, CDC changed the name of the cooperative agreement to the Paul Coverdell National Acute Stroke Program. As of July 2015, CDC is funding 9 states through the Paul Coverdell National Acute Stroke Program. This cooperative agreement is for a 5-year period, pending availability of resources.

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-2015 more than 550,000 patients benefitted from hospital participation in the PCNASP.

The mission of the PCNASP 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 the comprehensive stroke system across the continuum 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 PCNASP 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.

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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.

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. States 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 PCNASP 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 PCNASP.

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Dr. Frankel’s Coverdell Story: Improving Stroke Care in Georgia

Published October 27, 2015

As the lead neurologist for the Coverdell Stroke Program in Georgia, Dr. Michael Frankel engages hospitals to participate in Georgia’s stroke registry. Participating hospitals better connect the continuum of care so that physicians have more information to make the right decisions every time. The data show that stroke death rates are lower in the communities served by hospitals that embrace practices supported by Coverdell.

Coverdell Stroke Program: Ensuring That All Americans Receive the Highest-Quality Care

Published October 27, 2015

The Paul Coverdell National Acute Stroke Program, implemented by the Centers for Disease Control and Prevention, tracks and measures acute stroke care in order to improve the quality of care, from first contact with emergency medical services to the hospital and after the patient returns home from the hospital. The program works to improve stroke care nationwide and reduce stroke complications and deaths, particularly among those with the highest burden.

Success Stories

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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.

Program Publications

  • PCNASP Bibliography [PDF-336K]
  • Paul Coverdell National Acute Stroke Registry Program: Summary Report 2007–2012 [PDF-959K]
    The Paul Coverdell National Acute Stroke Registry Program funds states to improve the quality of care for stroke patients. This report provides a summary of the programmatic strategies and activities used by grantees during the 2007-2012 funding period. The information can be used by states and public health departments interested in starting a stroke registry and improving stroke care and access to care.
  • Paul Coverdell National Acute Stroke Program—Strategies from the Field [PDF-457K]Strategies 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.

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Related Links

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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].

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  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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