Paul Coverdell National Acute Stroke Program

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Heart disease is the leading cause of death in the United States. Cardiovascular Disease (CVD), including heart disease, stroke, and other vascular diseases, accounts for >800,000, or about 1 in 3, deaths/year, and around 1 in 5 who die from CVD are younger than 65 years. CVD is costly, with an estimated 15%, or 1 in 7 health care dollars spent on CVD. Stroke is the 5th leading cause of death and is a major cause of disability. After decades of decline, progress has slowed in preventing stroke deaths. About 795,000 people have a stroke each year. Someone in the United States has a stroke every 40 seconds and every 4 minutes, someone dies of stroke. About 610,000 of these are first or new stroke events and about 185,000 strokes—nearly 1 of 4—are in people who have had a previous stroke. Stroke costs the United States an estimated $34 billion each year, with this figure representing the cost of health care services, medicines to treat stroke, and missed days of work. The risk of having a stroke varies with race and ethnicity, but it is clear the risk of having a first stroke is nearly twice as high for Black individuals as their White counterparts, and Black persons have the highest rate of death due to stroke among all races/ethnicities. Stroke death rates among Hispanic individuals increased by 6% each year from 2013 to 2015. Stroke deaths also increased in southern states, where high burden populations, specifically communities of color, exist. High blood pressure (hypertension) is the single most important treatable risk factor for stroke and less than half of those with hypertension are controlled. High blood pressure is more common in non-Hispanic Black adults (54%) than in non-Hispanic White adults (46%), non-Hispanic Asian adults (39%), or Hispanic adults (36%). High blood cholesterol, smoking, obesity, and diabetes also significantly contribute to stroke risk and have a huge impact on high burden populations. These data are disturbing because about 80% of strokes are preventable. These data also highlight the critical need to improve access to and quality of care for those at highest risk for stroke events and stroke patients along the continuum of care, particularly among high burden populations. People of color experience disparities in access to health care, the quality of care received, and health outcomes. Analyses of data collected under previous cycles of this cooperative agreement found that women and African Americans were less likely to be treated with alteplase within 60 minutes. Other analyses determined that ischemic stroke patients who were women and Medicaid or Medicare recipients had lower odds of receiving defect-free care. A robust body of research supports the assertion that biases, both unconscious and implicit by clinical providers, can significantly impact health care delivery, clinical decision-making, patient-provider interactions, treatment decisions, treatment adherence, and the resulting patient health outcomes. This NOFO will build upon accomplishments, outcomes achieved, and lessons learned through CDC-RFA-DP15-1514 by focusing efforts on implementing a state-wide registry, along with evidence-based strategies to measure, track, and improve access to and quality of care for those individuals at highest risk for stroke events and for stroke patients from onset of stroke symptoms through rehabilitation and recovery. These efforts must accurately identify disparities and then effectively address the relevant inequities including identification, assessment, and treatment across the continuum of care for those at highest risk for stroke events and for stroke patients.

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