Policy Statement Highlights:
- A new American Heart Association/American Stroke Association Policy Statement lays out key policy levers needed to improve access to stroke rehabilitation and improve patient outcomes.
- The statement also outlines key evidence gaps in current stroke rehabilitation.
- The statement calls for developing and implementing performance measures that incentivize optimal patient care and improve stroke rehabilitation overall.
DALLAS, July 31, 2025 - Stroke remains a leading cause of long-term disability in the United States, and while treatments have advanced, systems designed to support stroke survivors in recovery continue to fall short of the needs of patients. A new policy statement from the American Heart Association, a relentless force changing the future of health for everyone everywhere, highlights major gaps in U.S stroke rehabilitation and identifies needed improvements in public policies and performance measures to incentivize optimal patient care. The policy statement was published today in Stroke, the peer-reviewed scientific journal of the American Stroke Association, a division of the American Heart Association.
Stroke is currently one of the most expensive medical conditions covered by Medicare. The economic burden of stroke is expected to increase by more than five-fold between 2020 and 2050, from $67 billion to $423 billion, the largest absolute increase in costs among various types of cardiovascular disease.
Despite the growing cost burden of stroke, access to stroke rehabilitation care is often not determined by clinical need, with large gaps in care based on race, geography, insurance type and socioeconomic status. Some patients, including those in rural areas, face steep barriers to accessing post-acute rehabilitation services, widening the disability gap compared to stroke survivors in urban areas.
"Clinical guidelines from the American Heart Association and American Stroke Association recommend that discharge planning and rehabilitation decisions be based on a stroke survivor's functional needs," said Nneka L. Ifejika, MD, MPH, FAHA, American Heart Association and American Stroke Association volunteer, chair of the policy statement writing committee and chief scientific officer at Ochsner Health System in New Orleans, LA. "However, research shows that non-clinical factors including the size and scope of a hospital network, a patient's insurance status and rehabilitation provider availability during the acute stroke hospitalization can limit access to appropriate care, resulting in poorer outcomes and higher long-term costs."
The policy statement outlines key measures to improve stroke care, including:
- Advance research that reflects real-world stroke recovery challenges by prioritizing patient-centered studies, addressing caregiving needs, mental health and long-term outcomes such as quality of life, return to work and community reintegration.
- Develop a national data infrastructure to track rehabilitation service utilization, costs (direct and indirect) and patient outcomes across diverse populations and care settings.
- Evaluate and compare rehabilitation models for their clinical effectiveness and cost-efficiency to determine what works best for stroke survivors.
- Study the impact of systemic factors—such as insurance coverage, geography, health systems and payment models—on rehabilitation quality and patient recovery to inform improvements in care delivery.
- Enhance care coordination and discharge planning by expanding staff training and addressing the unique needs of patients and their caregivers from varied social and economic backgrounds.
"The quality of one's recovery from stroke should not depend on their ZIP code, insurance status or the cultural competency of their health care providers when describing the importance of post-acute care," Ifejika said. "Every stroke survivor should be evaluated to receive high-quality, patient-centered rehabilitation, and should have equitable access if post-acute care is needed."
The American Heart Association is committed to advancing public policies at the federal and state levels that create optimal systems of care for stroke treatment, including rehabilitation and recovery.
The policy statement was prepared by the volunteer writing group on behalf of the American Heart Association Advocacy Coordinating Committee. American Heart Association policy statements position the Association on issues of public policy that will impact cardiovascular health and mortality, guide our advocacy work at all levels of government, allow us to support the important work of others, and inform policymakers, practitioners, health care professionals, researchers, the media and the public.
Authors, co-authors and members of the writing group are Nneka L. Ifejika, MD, MPH, FAHA, Chair; Mathew J. Reeves, BVSc, PhD, Vice-Chair; Oluwole O. Awosika, MD, MSCR; Terrie Black, DNP, MBA, FAHA; Pamela W. Duncan, PhD, FAHA; Richard L. Harvey, MD, FAHA; Douglas I. Katz, MD; Teresa J. Kimberley, PT, PhD; Barbara Lutz, PhD, RN, CRRN, PHNA-BC, FAHA; Flannery O'Neil, BA, MPH; Joel Stein, MD, FAHA; Anil V. Yallapragada, MD.
