Targeted Nursing Interventions for Improving Stroke Care and Outcomes in the Rural Setting: A Scientific Statement From the American Heart Association.

Abstract

Stroke remains a leading cause of morbidity and mortality in the United States, with rural-dwelling populations facing significant disparities in stroke prevalence, access to care, and outcomes. Rural-dwelling communities are particularly burdened by limited infrastructure and a higher prevalence of uncontrolled risk factors such as hypertension, diabetes, and obesity. Geographic isolation and long distances to medical facilities hinder timely access to acute stroke care. Nurses in rural settings are vital across the stroke care continuum, including prevention, acute management, and poststroke rehabilitation. They provide community-based education, conduct assessments, stabilize patients, and facilitate rehabilitation. However, rural-dwelling nurses face challenges, including limited access to specialized education, staffing shortages, and geographic barriers, that hinder the delivery of expert stroke care. Telemedicine and artificial intelligence-driven clinical support tools transform rural stroke care by enabling real-time specialist consultations and predictive analytics and enhancing decision-making capabilities. Despite its potential, telemedicine adoption in rural areas remains limited because of infrastructure constraints, resulting primarily from the high cost that low-volume facilities often cannot afford. This scientific statement explores the essential role of rural-dwelling nurses in stroke care and the barriers they face. Key initiatives are identified to enhance stroke care in rural areas, including telemedicine, artificial intelligence, innovative education models, and data-driven quality improvement efforts. Last, implications and resources for targeted nursing interventions to improve rural stroke outcomes, including promoting access to care through telehealth, ensuring ongoing education for rural-dwelling nurses, and advocating for the creation of stroke coordinator and champion roles in rural hospitals, are highlighted.