96% of Americans Live Within 60 Minutes of an Emergency Department With Acute Stroke Care

Emergency department, hospital
Investigators evaluated improvements in access to stroke care in the United States since 2011.

A cross-sectional study found that access to acute stroke care in the United States has substantially increased. These findings were published in JAMA Network Open.

In 2011, a study found that nearly 20% of individuals in the US did not have timely access to alteplase-capable hospitals. Since that time there has been substantial investment in increasing the number of stroke centers and the use of telestroke services.

To evaluate the progress in improving stroke care access, investigators from Massachusetts General Hospital and Harvard Medical School sourced data from the 2019 National Emergency Department Inventory and 2020 US Census Data. All emergency departments (EDs) were assessed for whether the ED was part of a stroke center or offered telestroke services. Each census block in the US was evaluated for 60-minute travel access to an ED with acute stroke expertise.

In 2019, there were 5,587 EDs in operation in the US. Among these centers, 46% were stroke centers and 45% had telestroke services. A third (36%) of EDs not in a stroke center had telestroke services compared with 63% of acute stroke-ready hospitals and 58% primary stroke centers.

The majority of census blocks were within 60 minutes of an ED with any acute stroke capabilities (96%); a stroke center (91%); a telestroke center (90%); a comprehensive, thrombectomy-capable, or primary stroke center (87%); or a comprehensive or thrombectomy-capable stroke center (64%).

Stratified by region, access was lowest in the Mountain West (91%) and highest in the Mid-Atlantic (99%).

There was a total of 13 million people (4%) without 60-minute access to a stroke center. Most of this population (60%) were within 60 minutes of a nontelestroke, nonstroke ED.

This study may have been limited by not independently validating the self-reported telestroke capacity of EDs.

This study found a substantial increase in acute stroke care access in the US with the overwhelming majority of census blocks with timely access. “Despite improvements in stroke systems of care, many Americans still lack timely access to acute stroke intervention,” the study authors wrote. “Addressing this care gap and other disparities in access will be critical to improving equitable access to acute stroke care for all Americans.”

Disclosure: Multiple authors declared affiliations with industry. Please refer to the original article for a full list of disclosures.


Zachrison KS, Cash RE, Adeoye O, et al. Estimated population access to acute stroke and telestroke centers in the US, 2019. JAMA Netw Open. Published online February 9, 2022. doi:10.1001/jamanetworkopen.2021.45824