Keys to survival include speed and expertise

Where are stroke centers? Click here for a map and a list, at least according to The Internet Stroke Center.

It stands to reason that stroke centers are the place to take stroke patients - as long as you can get to one relatively quickly. Read here about the question are stroke centers life savers?:

The odds of surviving a stroke are slightly better for patients treated at hospitals with a specialized stroke department, known as primary stroke centers, a new study finds.

But that benefit was only seen if stroke patients got to a stroke center in less than 90 minutes, the study authors said.

"Treatment of stroke is very time sensitive. As the saying goes, time is brain," said lead researcher Dr. Kimon Bekelis.

"So the faster you intervene, the faster the patient recovers," he said.

Time to up the game for stroke treatment

Photo by Chris Violette via Flickr

During the last couple of decades, we've seen some upgrade in care for stroke patients.

But this can't stop. Treatment could be so much better.

Check out the story on how experts call for care upgrade:

Patients suspected of having a stroke should be transported to an accredited comprehensive stroke center (CSC) when it is reasonable to do so, they wrote. When a CSC is too far away, patients should be taken to the nearest primary stroke center (PSC) that is linked to a CSC by telemedicine. They also called for the expansion of telemedicine networks linking smaller, non-PSC hospitals in very rural communities to accredited stroke centers.

"The qualifications for these PSCs and CSCs should be upgraded so that imaging technology and the availability of neurologists to see patients 24/7 should be requisites," the editorialists wrote. "Systems for rapid imaging and throughput should be in place at these centers."

How much priority will you get when it comes to saving your life?

This week's theme: Taking stroke patients seriously. Sadly, we are not always taken seriously.

This is written in kindness - my life was saved by health professionals in a hospital. But we've all seen the other side in hospitals - the hurry-up-and-wait phenomenon. And in my own personal observations, transportation is a big issue for hospitals.

So it's not a big surprise that in those cases in which a stroke patient needs to move to a stroke center, the transfer is actually no faster than driving yourself:

Legislation about stroke centers can make a real difference

Where do you live? Where's the closest stroke center?

We've all seen lots of evidence that where you live has a lot to do with your health. Local diet. Cultural expectations about exercise. Access to healthy food choices. Access to places where you can safely take a walk.

And access to stroke centers, according to recent research showing how state stroke center laws have a real impact:

States with some of the highest percentage of acute care hospitals with designated stroke centers were Delaware (100%), Massachusetts (97%), New Jersey (96%), and Rhode Island (90%).

Living too far away from stroke centers

Too far, too long.

Rural America is especially hard hit when it comes to stroke centers "over an hour away" for one third of Americans:

"Even under optimal conditions, many people may not have rapid access to comprehensive stroke centers, and without oversight and population level planning, actual systems of care are likely to be substantially worse than these optimized models," says Dr. Mullen.

Levels of access to care also varied in different geographical areas. Worryingly, access to care was lowest in an area often referred to as the "Stroke Belt" - 11 states where stroke death rates are more than 10% higher than the national average, predominantly situated in the southeast of the US.

"Reduced access to specialized stroke care in these areas has the potential to worsen these disparities," says Dr. Mullen. "This emphasizes the need for oversight of developing systems of care."

So the people who are most likely to need the care are also the most likely to be too far from care. We can - and must - do better.

Stroke signs and stroke centers

Knowing stroke signs is important - but what to do next is also vital.

A recent article in the Philadelphia Inquirer offered a resource on finding stroke care. A primary stroke center must meet a certification standard that elevates patient care:

A primary stroke center is an acute-care hospital that meets certain criteria for delivering stroke care and adheres to practice guidelines designed to improve outcomes for patients with warning signs or symptoms of stroke.

If you or a loved one may be having a stroke, call 911 immediately and ask for transport to the nearest primary stroke center.

Click here for a map of stroke centers across the United States - sadly, only updated as of 2010. It's not the most user-friendly map. To see a map of stroke centers, click on the button labeled Map Options, choose the tab called Layers and choose the latest-available year of primary stroke centers.

You'll get a map similar to the image, and you can zoom in for more detail. As you can see, west of the Mississippi, they become sparse.

Study shows Chicago policy may help stroke patients

You've seen postings before about using accredited stroke centers when possible. Now, a recent study shows a link to those centers and better treatment. You can follow this link and read about how a study shows citywide policy may help stroke patients recover:

A citywide policy enacted in 2011 — involving Chicago ambulance crews taking suspected stroke patients directly to accredited hospitals with accredited stroke centers — was associated with increased usage of a therapy that can reverse the effects of a stroke if received in time, according to a study published in the journal JAMA Neurology on Monday.

Before the change, rates of stroke patients getting what’s known as intravenous tPA [tissue plasminogen activator] was 3.8 percent of all patients. After, it improved to 10.1 percent.

 

One more reason to get help fast!

If you've visited this blog before, you've heard this line before: If you are having any stroke sign or symptom, even one, call 911 and get to an emergency department that is a stroke center quickly.

Even a mini-stroke - a transient ischemic attack, or TIA - can be a harbinger for a full-blow stroke. Now, we find that according to one study, 'mini strokes' are linked to doubled heart attack risk:

Although TIA symptoms may last only a few minutes, they are a warning of coronary heart disease that may be unrecognized, said Dr. Larry B. Goldstein, a professor of medicine and director of the Duke Stroke Center at Duke University Medical Center, who was not involved in the study.

The study confirms that "people who have had a TIA or stroke should also be evaluated for coronary heart disease," said Goldstein.

Educate yourself about key stroke treatment

Not long ago, finished reading a book about a subject near and dear to my.... brain:


tPA for Stroke: The Story of a Controversial Drug, written by Justin A. Zivin, M.D. Ph.D, and John Galbraith Simmons traces the history - and the initial reluctance of  acceptance of the drug for stroke patients - of the drug I'm convinced prevented my serious disability or even death.

I came into a hospital unable to speak, write or move the right side of my body. Last Saturday, I ran 10 miles. I can speak and, some say, write. Would I have recovered to this degree anyway? Doubtful. While my physical impairments went away quickly, it took several weeks of speech therapy to recover my reading/writing skills to get back to work. I dread what would have happened without  tPA - tissue plasminogen activator - involved in my care. In a few postings, I've called it the Lazarus effect..

The book walks through a couple of cases in particular - one stroke victim receiving tPA and the other one not - with striking differences. Sadly, while stroke centers are appearing across the United States, tPA is still not widely known in public circles. And if it's now well known, it's harder to be an effective advocate for a stroke victim who can't speak. The medication can only be used in a certain window of time, and the patient needs some imaging and exam to make sure it's the right drug. So time is critical.

Take a read of this book and you'll arm yourself with key knowledge. Every year, about 800,000 people have a stroke in the United States. The book could very well help you save a life - someone you love, or even your own.

To quote the book listing on Amazon:

Without warning stroke can paralyze, blind, or kill. Some victims recover, but many do not and may even suffer another disabling or fatal attack. The drug known as tPA can drastically reduce the long-term disability associated with stroke, but despite its near-miraculous capabilities and the growing support of most neurologists, it has been slow to win acceptance as the standard of care in emergency departments nationwide.

Time for more people to know about tPA

Like most people in 1998, I'd never heard of a drug called tPA (tissue plasminogen activator).

Sadly, too many people still don't know about it.

I recently became aware of a new book, "tPA for Stroke: The Story of a Controversial Drug" that digs into  why it's still largely unknown. The authors - Dr. Justin Zivin, a professor of neurosciences at the University of California San Diego who performed some of the earliest experiments that showed tPA could be used to treat stroke patients, and science writer John Galbraith Simmons - describe in detail the drug's controversial history.

In 1998, it had only been approved for stroke patients for a couple of years (1996) by the U.S. Food and Drug Administration. TPA acts to clear blood clots lodged in the brain - the main cause of stokes - allowing blood flow to resume to the brain. I am convinced that without the drug, at best, I would currently be disabled or, at worst, would have died that day. But because a willing neurologist happened to be available in a small-town hospital just two years after the drug was approved, I'm alive and well.

Thanks be to God.

Zivin recently talked with the San Diego Union Tribune not long about about the little-used drug that can minimize stroke damage:

Every 40 seconds, it happens to someone, somewhere in the United States. Stroke. It’s the third leading cause of death after heart disease and cancer, killing the victim in roughly three out of 10 cases while leaving many survivors with permanent brain damage and paralysis.

There is a drug, however, that can, if taken soon enough, minimize the consequences of a stroke, even produce a recovery so remarkable that it’s difficult to believe the patient ever even had a stroke. The drug is called tPA. Most stroke victims never get it.

And that's a shame. People need to know the stroke signs, call 911 and get the stroke victim to a stroke center - fast.

No age barrier to thrombolysis in stroke?

This blog references a lot of stories about the under-50 (or even 40!) folks who have had strokes. But a reverse story, from Glasgow, Scotland, was published not long ago, based on a study for older patients treated with clotbusters for stroke:

Patients over age 80 with acute ischemic stroke fare better when treated with intravenous thrombolytic therapy than when left untreated, a new analysis shows. They derive benefits from thrombolytic therapy similar to younger patients, are not at significantly greater risk for intracranial bleeding, and, therefore, should not be denied this treatment based on age alone, investigators conclude. ...

"For most stroke physicians, the findings will confirm their suspicions and reinforce their practice," senior study investigator Dr Kennedy R Lees (University of Glasgow, Scotland) noted. "The unfortunate truth is that many older patients will have missed an opportunity for treatment and are now living with the consequences, if they even survived. We hope that now age will not be a barrier to treatment."

More important than ever for all stroke patients - young or old - to get to a stroke center as soon as possible.

Drug isn't always used to battle a stroke

Another strong reason to make yourself aware of stroke signs and symptoms, plus what to do if it happens to yourself or someone you know. Even if you get to the right place in time, proper treatment is still not a guarantee, as this article illustrated.

Drug that could stop stroke isn't always used:

While a growing number of hospitals boast that they are equipped to use the clot-dissolving drug, they don't always do so, a Journal Sentinel investigation found. And the organization that certifies those hospitals as stroke centers doesn't require that they actually offer the drug to eligible patients.

The clot-dissolving agent, known as tissue plasminogen activator, or t-PA, is the only approved drug for treating a stroke by stopping it and significantly reducing the risk of disability.

Yet the number of patients who get t-PA has remained dismally low, about 5% of all stroke patients, ever since the drug was approved 14 years ago. Much of that is because patients fail to recognize their symptoms and get to the hospital within the 4 ½ -hour window during which the drug can be administered.

It is not all the fault of patients.

This is a great and informative article about stroke centers and stroke treatment, or, too often, the lack thereof.

Is every stroke patient a candidate for this drug?. No. That's why we want training of health professionals so they'll do the best job they can do. It's also illustrates the importance of the need for advocates for patients. Often, the patient can't speak clearly or isn't completely lucid after a stroke. That's why it's so important for someone to be able to speak on the patient's behalf.

Take this story as a valuable lesson on those two points.

More places, more hope

Number of U.S. Stroke Centers nearly double since 2006 | Stroke Awareness Foundation Blog

Nearly 80 percent of the population (250 million residents) lives within an hours drive of a stroke center and nearly 211 million residents lives within a 30-minute drive.

TIA care in the right places does matter

They aren't strokes, exactly, but take a TIA seriously.

A transient ischemic attack "a brief episode of a given neurological abnormality that resolves on its own, and by definition, TIA sufferers recover completely within a few minutes (or a few hours, at the most)," according to the recent article stroke hospitals offer better care for TIA patients.

And not surprisingly, stroke hospitals (those with stroke units) appear to be better than [other] hospitals at doing this. This is probably due to the presence of stroke experts in their facilities, which guarantees that patients with TIAs undergo rapid and thorough testing. This was shown in a recent article in the Medical Journal of Australia.

So be sure you know the TIA symptoms and take them seriously. Don't let anyone you care about - hey, that should be everyone, right? - just shrug it off. TIAs can be signs of a even more serious events to come. If you can, get to a stroke center, as they are called in the U.S. You can find them here if you pick your ZIP Code, with a range of at least 25 miles, choose Type of Service and choose a Certified Program called Stroke (Primary Stroke Center).

Just because you're young ...

Recent Reuters article shows that even health professionals can misdiagnose a stroke - for those who don't fit the mold.

Because the typical stroke victim is age 55 or older, an emergency room's staff may not suspect a stroke when a patient under 45 arrives with telltale symptoms, the researchers said.

They urged doctors to be vigilant for signs of a stroke even if the patient is young, noting the importance of quick treatment to prevent lasting damage.

"Accurate diagnosis of stroke on initial presentation in young adults can reduce the number of patients who have continued paralysis and continued speech problems," Dr. Seemant Chaturvedi of Wayne State University in Detroit, one of the researchers, said in a statement.

As other blog entries have noted, the move to get stroke patients to the right location for proper treatment is a great step forward. Another important move is to make sure the people who deal with emergencies - those who answer 911 calls, those who respond to those calls, ER staff, etc. - are aware of the signs and can help make life-saving decisions.

That includes you - even if you're under 40, it can still happen to you. Believe me, I know.

Not just a stroke of luck

Not that I believe in luck, but an article from Nurse.com - Not Just a Stroke of Luck - talks about an initiative that should happen - or already happening - everywhere:

Nurses from competing hospitals are joining together to improve the care that stroke patients receive at hospitals throughout New Jersey.

As in many circumstances, nurses wind up coordinating stroke centers, the article says, and special training helps to improve that coordination. Thus the effort in New Jersey. Efforts to upgrade stroke care coordination should either be ongoing or about to begin everywhere.

Law sets up guidelines for stroke care

Good news for fellow Missourians. As reported in the Springfield News-Leader, a bill was signed into law setting up guidelines for stroke care. From the newspaper:

Stroke and heart attack patients across Missouri could soon get the right intervention faster, and in the right setting, boosting their chances of survival.

Gov. Matt Blunt on Friday (July 11) signed legislation creating a 'Time Critical Diagnosis System' for stroke and a fatal type of heart attack called ST-elevation myocardial infarction, or STEMI.

Missouri is the first state in the nation to enact legislation calling for guidelines for designating stroke and STEMI centers, a Blunt news release said.

"The sooner we treat people, the better they do," said CoxHealth Dr. Scott Duff. He was among CoxHealth and St. John's Hospital doctors and staff who helped develop the legislation.

The idea is to get stroke or heart attack victims into a setting that gives them the best chances of recovery.

More details on the snake venom research

Last posting linked to a news article about research in using snake venom to treat stroke patients. A more technical and detailed link can be found with the Internet Stroke Center's Stroke Trials Registry.

The page describes the efforts to learn about the results of an intravenous infusion of ancrod - pit viper venom - within six hours of a stroke. The study looks at patient status three months afterward.

The study is still recruiting facilities and patients to take part in the study.

Internet Stroke Center at Washington University

Yesterday's post mentioned the Internet Stroke Center at Washington University in St. Louis. It's also connected with Barnes-Jewish Hospital, which is next door to the university's medical school.

The Internet Stroke Center offers resources for patients and families, including basics on recognizing stroke symptoms, caring for stroke survivors and reducing stroke risk. There's a link to the latest stroke news. It's a good Web site to note during Stroke Awareness Month.

One of the more disappointed stories, from MedWire News, starts this way: "Only a fifth of people who suffer a stroke recognize the event as an emergency and go urgently to hospital, research reveals." That means, of course, four out of five people who suffer a stroke do not recognize the event as an emergency and go urgently to a hospital. We need to do better. Much better.

Here are the symptoms:

• Sudden numbness of the face, arm, or leg, especially on one side of the body
• Sudden confusion, trouble speaking or understanding speech
• Sudden trouble seeing in one or both eyes
• Sudden trouble walking, dizziness, loss of balance or coordination
• Sudden severe headache with no known cause

Even if you suspect that's going on - to you or someone else - get to some help fast. As stated before, a false alarm is better than a funeral.

Being several days out of my effort to post to this blog almost every day and keep it active, I've found it gets easier every day and discovered some fascinating people and additional resources. And on that note, thanks be to God.

Aspirin can help

For Stroke Awareness Month, you might want to consider this easy and cheap preventive measure: taking a baby aspirin.

The St. Louis Post-Dispatch quoted Dr. Abdul Nassief, an assistant professor at Washington University and director of the clinical stroke center at Barnes-Jewish Hospital, that an 81-mg aspirin, every other day, reduces stroke risk. He cautioned against taking it, though, if your blood pressure is more than 140/90.

"It's a winner," Nassief told the newspaper. "And for women over 40, a baby aspirin every other day reduces the risk of stroke by 25 percent." And it doesn't matter if it's coated or uncoated, although the coated aspirin might cause less upset.

Not being a doctor myself, I'd always check with my doctor to see if there's any other reason not to take the aspirin, especially if you're already taking a prescription medication.