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Review
. 2025 Jun;56(6):1650-1654.
doi: 10.1161/STROKEAHA.124.048942. Epub 2025 May 23.

American Heart Association Standards for Postacute Stroke Rehabilitation Care

Joel Stein  1 , Samuel M Bierner  2 , Steve Dentel  3 , Aly Downs  4 , Mark Kovic  5 , Barbara J Lutz  6 , Madeline Pawloski  3 , Kylie Picou  3 , Janna Pietrzak  3 , Sue Pugh  7   8 , Kathleen Volkman  9 , Kristy Weissling  10 , Richard Zorowitz  11 , Pamela W Duncan  12
Affiliations
Review

American Heart Association Standards for Postacute Stroke Rehabilitation Care

Joel Stein et al. Stroke. 2025 Jun.

Abstract

Evidence-based rehabilitation and secondary prevention interventions improve poststroke functional recovery and reduce secondary complications. However, stroke rehabilitation expertise, processes of care, and educational resources vary among sites where postacute care (PAC) is delivered. The American Heart Association developed quality standards based on the American Heart Association 2016 Guidelines for Adult Stroke Rehabilitation and Recovery to address these gaps. An interdisciplinary PAC standards writing committee identified key areas for PAC: quality improvement, medical management, care coordination, patient/caregiver and personnel education, and program management. Subgroups developed draft standards, combining results from a national landscape survey of PAC sites with clinical practice guidelines. The committee then refined the draft standards using a consensus-based process. American Heart Association staff and PAC sites in Montana convened a learning collaborative to gather feedback and provide gap analyses of the standards relative to current practices. Qualitative input from beta testing in Montana and quantitative results from the nationwide survey and Montana sites were analyzed and used to refine the standards further. The national landscape survey demonstrated that most sites do not meet the proposed standards: stroke program oversight structure (78% fall short), stroke rehabilitation leadership (70%), stroke-specific order sets/protocols (61%), and policies requiring staff stroke education (66%). Regarding Montana findings, 41% of the PAC sites have no mechanisms to identify areas of quality improvement specific to their stroke rehabilitation programs, and 59% do not use standardized tools to ensure that performance improvement initiatives are followed. However, with adequate support and resources, most Montana sites stated that they would be able to meet the proposed standards. We conclude that the Stroke PAC Quality Standards are applicable in PAC settings and provide a pathway to improving access to high-quality care for stroke survivors. Outcome studies are needed to confirm anticipated improvements in medical and functional outcomes.

Keywords: patient discharge; recovery of function; rehabilitation; stroke; stroke rehabilitation.

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Conflict of interest statement

Dr Bierner’s employer receives research funding from the Center for Biomechanics, Rehabilitation and Manufacturing and legal consulting fees from Fee Evans, Row, and Holbrook. Dr Duncan owns stocks with Care Directions, a start-up digital platform that assists with patient-centered care management. Dr Lutz receives research funding from the Patient-Centered Outcomes Research Institute, the National Institutes of Health (NIH), and the American Heart Association. She is also compensated by MedBridge, Inc, for online nursing Continuing Education Unit lectures, and has a patent pending for PATH2Caregiving, a caregiver mHealth training app. Dr Stein’s employer receives research funding from BrainQ, Microtransponder, the NIH, and the New York State Spinal Cord Injury Research Board. He is also compensated as a consultant to MedRhythms, BrainQ, and Dessintey. K. Weissling receives grant support from the US Department of Education and other support from the Nebraska Stroke Association. She is employed by the University of Nebraska-Lincoln. She receives royalties from a presentation for MedBridge, Inc. Dr Zorowitz receives research funding from Ipsen Biopharmaceuticals, Brain Q, and NIH StrokeNet. The other authors report no conflicts.