Hospitalized stroke patients receive worse care

I've written before about the value of showing up in an ambulance for better care. And you'd hope that once you're in the hospital, you'd be in excellent care. Now, some recently released statistics indicate that stroke patients already in the hospital receive worse care:

Stroke patients receive better care if they have their stroke outside the hospital than in the hospital. These worrisome findings come from a study based on data from the American Heart Association's Get With the Guidelines program.

"Maybe the emergencies we are least prepared for are the emergencies that happen in our very own backyard," Ethan Cumbler, MD, said here at Hospital Medicine 2013. ...

Defect-free care, defined as the proportion of patients who received all of the achievement-measure interventions for which they were eligible, was significantly worse for in-hospital stroke than for community-onset stroke... .

"The gap in defect-free care was larger than I expected," Dr. Cumbler told Medscape Medical News.

This also might show the value of being an advocate for someone in the hospital.

Rising costs - yet another reason to prevent strokes

We already now that stroke is the largest cause of disability in the United States and fourth leading cause of death. Now, there's another reason to emphasize stroke prevention. MedPage Today reports that stroke costs to double by 2030, groups say:

Annual stroke-related medical costs are projected to jump from $71.6 billion in 2012 to $183.1 billion in 2030, according to a statement from the organizations in the August issue of Stroke.

Total annual costs, including the price of lost productivity, were estimated to rise 129% to $240.67 billion by 2030, Bruce Ovbiagele, MD, MSc, of the Medical University of South Carolina in Charleston, and colleagues reported in the statement. ...

"The biggest bang for buck would be primary prevention," he [Bruce Ovbiagele, MD, MSc, of the Medical University of South Carolina in Charleston] told MedPage Today in an interview. "We know it works but we know we have a lot of room for improvement. We could do more."

Click here for more about stroke prevention - money aside, it can save a life.

Spotting stroke signs quickly

May is Stroke Awareness Month, and I hope you will see this information multiple times - it's very important. But through my trusty Google alerts, I found a nice presentation of  signs of stroke:

"When someone has a stroke, they may show either slight or extremely noticeable physical changes," Dr. Randolph Marshall, chief of the stroke division at New York-Presbyterian Hospital/Columbia University Medical Center, said in a hospital news release. "The most effective way to prevent the permanent damage associated with stroke is to recognize the signs of an attack and to seek medical attention immediately."

Dizziness and trouble walking, loss of vision in one or both eyes and a severe headache that comes on suddenly for no apparent reason are other signs that someone is having a stroke. Early treatment, however, can prevent or possibly reverse the damage caused by strokes. The experts advised remembering the acronym "FAST" to help people recognize a stroke sooner and reduce any long-term damage:

• F for Face: Does someone's face look uneven?
• A for Arm: Do you notice one arm hanging down?
• S for Speech: Check for slurred speech or other signs of trouble speaking.
• T for Time: Call 911 and seek immediate medical attention.

Please click on the link above and read all of it. Stroke is the leading cause of disability in the United States, and the country's fourth largest cause of death. Taking quick action might make a huge difference.

Another reason to take depression seriously

Even to this day, depression is too often not taken seriously. Now, a recent study shows another reason to take depression seriously and seek solutions. The study showed that depression may be stroke trigger in women:

Depression appears to be a risk factor for stroke among middle-age women, even after accounting for other variables, an Australian study showed.

Among women in their late 40s and early 50s who were followed for up to 12 years, meeting criteria for depression was associated with more than double the likelihood of having a stroke ..., according to Caroline Jackson, PhD, and Gita Mishra, PhD, of the University of Queensland in Australia. ...

"Our findings contribute to the currently limited evidence on potential age differences in the association between depression and stroke, and suggest that the effect of depression may be even stronger in younger women," they wrote

Diabetes and stroke risk

As if we didn't have enough evidence that watching our personal health no matter our age is important, a recent article brings in more.

Diabetes increases stroke risk, particularly in under-65s:

"Our results suggest that diabetics aged under 65 have up to a 12-fold increased risk of stroke compared with people of a similar age who do not have diabetes," lead investigator Dr Jane Khoury (Cincinnati Children's Hospital Medical Center, OH) commented in an interview. "In the over-65s, there was still an increase in stroke of about two- to threefold in diabetic patients."

'Our salvation in time of distress'

Lord, be gracious to us;
    we long for you.
Be our strength every morning,
    our salvation in time of distress.

-Isaiah 33:2

We've all had distress, stroke-related or not.

Last week, I marked my 15th "anniversary" of my stroke, and remarked how God gave me strength in my recovery.

That strength is available to you, every day, especially in time of distress, as the above quote from Isaiah notes.

These days, I exercise most mornings. When I run this morning, I will thank God for the strength of that morning. No matter your schedule, even when your "morning" is everybody else's afternoon, you, too can reach out for that strength and salvation.

(Photo from NASA; text added by author)

Stroke prevention reminder for Stroke Belt folks

I spent my youth (and many adult) years in the Stroke Belt (Arkansas), and mine came a little over 15 years ago, also in Arkansas.

Does living in Arkansas (or other Stroke Belt states) guarantee a stroke? Of course not. But during Stroke Awareness Month, a reminder that taking stroke prevention measures can't start too soon.

Click here to read how teen years put the "Stroke" in "Stroke Belt":

Overall, the strongest predictor of stroke risk was the proportion of one's entire life spent in the so-called stroke belt, which encompasses much of the Southeast. After adjustment for other stroke risk factors, though, the proportion of adolescent years in the stroke belt remained the only significant predictor, increasing stroke risk by 17%.

"Our data suggest that living in the stroke belt during adolescence may contribute to the higher stroke mortality in the stroke belt, and the harmful effects associated with living in the stroke belt may be greater for black than white subjects," Virginia J. Howard, PhD, of the University of Alabama at Birmingham, and co-authors concluded in the April 30 issue of Neurology.

"Improvement in childhood health circumstances should be considered as part of long-term health improvement strategies.""

Fifteen years ago today...

Fifteen years ago, this was a bad day. But the day could have been far worse.

May 8, 1998, started as a busy work day for a reporter, starting with two-hour drive from Little Rock, Ark., to Batesville, Ark. Fellow reporter Sandy Davis and I were sitting in a government office, sifting through boxes of documents.

About noon, my right arm and right leg fell useless. I could not speak. I was in the grip of a stroke. Sandy got help. An ambulance crew took me to White River Medical Center.

For this 15th "anniversary" of my stroke, I spoke with Dr. John O. Collins, the neurologist who treated me with the clot-busting drug tissue plasminogen activator, or tPA. At the time, he was practicing in Batesville, the small town where I grew up. Not long before, he'd finished a medical residency at the University of Maryland School of Medicine in Baltimore.

I was the first patient he administered tPA to on his own.

"You were a classic case," he said. Within an hour of my symptoms, a CT scan showed a blood clot, in the left side of my brain. About two hours after my stroke, the tPA started flowing. Shortly afterward, I showed clear signs of recovery. My arm and leg could move once again. I struggled with speech but that, too, came back.

The drug tPA was rarely used in 1998 - especially at small town hospitals. It's still used only 5-10 percent of the time, often because people don't get to a hospital in time for the treatment, Collins said.

He stayed in Batesville for four years and now practices in Fort Wayne, Ind., where he  frequently works with stroke survivors in their recovery.

He was one of a series of health professionals, along with colleagues, friends and my wife, Laura, who helped me recover physically and regain my abilities to speak coherently and eventually to write again.

I thank God for all those people. He gave me their help and the strength to get through some struggling recovery times.

But as the first blog posting here back in 2005 states, it's really not about me. The purpose of today's posting is to remind people to know the stroke signs and symptoms and don't delay getting help. You can save or change a life.

Avoiding an ambulance can be tragic

Too often, people wind up at a hospital too late for the best stroke treatment. Another story made the rounds, this time how a third of stroke victims delay action by avoiding ambulance:

When patients were taken by ambulance, 79 percent of them got to the hospital within two hours after they first started to notice symptoms. That’s crucial, said Wallace, who has specialized in stroke treatment since the mid-1990s. The most common form of stroke can be treated in most cases with a clot-busting drug. But it must be injected within a maximum of 4½ hours from the onset of symptoms, and it’s better if injected within three hours, she said.

“That means a person has to have symptoms, recognize it, get into the hospital, be seen by us, get a CAT scan of the brain, IV started and a decision made, all within 180 minutes,” Wallace said."

Look tomorrow for another - very personal - story showing the importance of getting to help in time.

Stroke awareness - a global issue

May is Stroke Awareness Month, but stroke awareness is a global issue. And as I've blogged many times, it's not just an senior citizen issue. Here's one more example why - Swedish stroke data has good news and bad:

Overall ischemic stroke rates have declined sharply in Sweden over the past 25 years, and one-year mortality rates after a first stroke have been halved across all age groups, according to new longitudinal research. But in a troubling new finding, rates of first stroke, as well as four-year mortality rates after an initial stroke, are on the rise among younger Swedes.

Dr Lena Björck (University of Gothenburg, Sweden) and colleagues presented the new data in a trio of posters here at EuroPrevent 2013. ...

But the rate of deaths over the years has been declining, she noted. "The mortality after stroke is decreasing in all age groups, over a long period—1987 through 2010. And that's a positive thing," she said. And of note, while the numbers are most striking in the older patients, where stroke is more common, the relative risk reduction was actually slightly greater in the youngest group (age 18-44) than in the 45-64- and 65-84-year-old groups."