Where did your stroke happen? Geography might impact treatment

Photo from David Kessler via Flickr

Last week, the posting was about people born in the "stroke belt" region.

So for a related item, a look at cholesterol-treating drugs seem less likely to be prescribed in the stroke belt, with no statin prescribed for half of stroke survivors:

But inside the so-called Stroke Belt region, seniors were 47% less likely to be discharged on a statin, and men were 31% less likely to get a prescription for the lipid-lowering drugs than women. Neither association was seen outside the Stroke Belt.

"All survivors of ischemic stroke should be evaluated to determine whether they could benefit from a statin, regardless of the patient's age, race, sex, or geographic residence," lead author Karen Albright, PhD, DO, MPH, of the Birmingham VA Medical Center, said in a press release.

Helicopters delivering doctors for stroke patients

Most of us have likely seen helicopters carrying patients to hospitals. Now, there's the idea that flying doctors to stroke victims may improve outcomes:

Transporting doctors to stroke victims could be one viable way of bringing the procedure to more patients, Hui believes. He has been flown to Suburban Hospital to treat three patients this year. Early indications are that it is less expensive and faster than transporting a patient to the doctor.

In a case study of one those incidents printed in the Journal of Neurointerventional Surgery earlier this month, it took Hui 77 minutes to fly to the hospital and complete the procedure. The helicopter took off for the 19-minute flight from Hopkins to Montgomery County at 12:24 p.m. At 1:07 p.m. Hui inserted the catheter into the patient and he completed the surgery by 1:47 p.m.

The full process took about the same amount of time as it would have if Hui had performed the procedure on a patient at Johns Hopkins because doctors at Suburban prepped the patient before Hui arrived to the hospital. It likely would have taken longer to prepare the patient to be transported to Hopkins, let alone travel time and preparation and surgery once there, he said.

Although the study wasn't designed to look at the health outcome of the patient, studies have shown that timing is crucial when treating stroke patients because patients lose brain capacity with each minute they are not treated. Stroke victims do best when they are treated as quickly as possible — ideally in 100 minutes or less.

Type of stroke location might be relevant to new treatment

Last week, we had a post about new stroke treatment. Not long afterward, I ran across another story about how - potentially - to decide on treatment. I might have to do with large-vessel strokes related to blood clots:

“There was some benefit of therapy up to 7 1/3 hours after onset — that’s an important new aspect,” Jeffrey L. Saver, MD, of David Geffen School of Medicine at UCLA, said in a press release. “If you get the artery open at 3 hours, 65% of patients will be able to live independently 3 months later. If it takes 8 hours to get it open, then only 45% will be able to live independently. It makes a major difference in outcome.”

Speed and the right place - more important than ever

Sooner the treatment, better the outcome.

You've read this before here - time is critical in getting a stroke patient to a stroke center hospital. Every minute counts.

You've also read about recent research on new stroke treatment. Now, read about how the new treatment calls for getting to the right place quickly:

That’s the implication of a study published Monday in the Journal of the American Medical Association that found that the sooner patients with severe strokes receive a thrombectomy, the less disabled they tend to be three months later.

Adding choices for possible stroke treatments

Last post, I included a link to my own story about the clot-busting drug tissue plasminogen activator, better known as tPA.

Keep in mind, though, that my story is 18 years old. And still, tPA is the only approved drug to treat clot-caused strokes. I ran across an interesting story about the reason why the drug doesn't work every time, and what seems to be coming next:

Twenty years ago stroke doctors celebrated the arrival of a powerful new weapon: the clot-clearing drug tPA. It was hailed as a lifesaver and has proved to be one for hundreds of thousands of patients since. TPA was the first and is still the only medicine approved by the U.S. Food and Drug Administration for treating strokes caused by clots that block blood flow to the brain. But like so many medical marvels, tPA (which stands for tissue plasminogen activator) has turned out to have serious limitations.

Another tool for important tasks

I have a hammer. I also have an air compressor and a few nail guns.

So, which tool should I use to hang a picture on a wall?

On the other hand, I once had the need to place a piece of cedar siding around 24 feet above the ground. One hand held the siding, but using a hammer is a two-handed operation. Now which tool should I use?

So I see the importance of health professionals with more tools to do the important work of treating stroke patients. Check out the story on the FDA approving a clot-picker use with tPA:

Two Trevo clot retrieval devices were approved Friday by the FDA for use in conjunction with tPA thrombolysis in acute ischemic stroke patients.

Mini-stroke can lead to a big problem - take it seriously

Take mini-strokes seriously - that's the bottom line of some interesting research. Read more how aggressive treatment of "mini-strokes" lowers risk for major stroke:

Better and faster use of secondary stroke prevention methods after transient ischemic attacks, or TIAs, helps reduce risk of additional strokes and death, according to researchers involved with an international study.

With the most aggressive care available, researchers at 21 sites around the world cut in half the risk of a second stroke among participants in the five-year study, which is published in the New England Journal of Medicine.

So don't just sit there - take action if you see the symptoms!

Good advice - find the balance between treatment risks and benefits

Photo from U.S. Centers for Disease Control and Prevention

Now, as Paul Harvey used to say, the rest of the story.

I've posted quite a bit about high blood pressure as a stroke risk. It's the leading cause of strokes.

A wise doctor, as part of taking care of my aging mother a few years ago, described health decisions about her as a balancing act. Take this medication, and it might affect that ailment, which might affect other medication, and so on and so on. Truer words were never spoken.

Now, here's some thoughts to consider about high blood pressure, new targets and possible medication side affects, in an article stating that new blood pressure guidelines a danger to patients:

Preventable strokes and treatment - finding answers, saving lives

Photo from Pete via Flickr

I'm sold on stroke prevention. It saves lives and it gives society more resources to battle health problems.

An interesting research take about 'preventable' strokes and treatment:

Three out of four strokes could be avoided, and one in four are "highly avoidable," according to a study assessing stroke preventability. It also found that strokes considered the most treatable were the most preventable.

Those were the findings when a 10-point stroke preventability scale -- incorporating key measures such as treatment for hypertension, high cholesterol, and atrial fibrillation -- was applied to 274 consecutive ischemic stroke patients treated at a single institution. ...

Hospitals hiring weight-guessers? Or is there a better solution?

Image from Wellness Corporate Solutions via Flickr

Ever seen someone offering to guess your weight at a carnival? It's been a while for me.

Maybe we need to hire some of those folks for hospital work - when knowing someone's weight means administering the correct amount of a drug that could bring you back from a stroke, or put you in danger - at least partly depending on how the accuracy of your weight in its calculation.

Recently, some research shows that weight guesses for stroke treatment are often wrong:

"Relying on our ability to 'guess' the weight of a patient in the acute setting is no longer acceptable and potentially dangerous," Pankaj Sharma, MD, PhD, from the Institute for Cardiovascular Research at the University of London, told Reuters Health.

The recommended dose of alteplase (recombinant tissue-type plasminogen activator [r-tPA]) is 0.9 mg/kg, up to a maximum dose of 90 mg. In the interest of time, clinicians often estimate patients' weights to determine the r-tPA dose. ...

Was your stroke an emergency? Not all that long ago...

Photo by Chris Violette via Flickr

We've gone a long way.

Twenty years ago, a stroke wasn't considered an emergency. No treatment to reverse or limit a stroke's brain damage.

In 1996, the clot-busting drug tissue plasminogen activator was approved to treat strokes. That also caused a great deal of rethinking how health care providers responded to strokes. What was not an emergency suddenly became one. That meant a lot of rethinking of roles and actions of health professionals when a stroke happens.

An interesting take on that history and more ideas evolving, focusing on when stroke care is a statewide effort:

Where are you? And why should that matter for stroke treatment?

Place can have a lot to do with your health. That's been demonstrated, and experts have talked about diet, access to providers, lifestyles and more.

But a recent study has its own author puzzled about baffling disparities in stroke treatment across the United States:

In the bottom one-fifth of the hospital markets patients received no tPA. In the top one-fifth of markets 9% of patients received clot-busting drugs. In Asheville, NC and Stanford, CA as many as 14% of patients received IV tPA or an intra-arterial treatment using tPA or another drugs.

There were only minor improvements in treatment levels for patients in regions with certified primary stroke centers, or where emergency medical services drove patients further to get stroke treatment. Older patients, minorities, and women were less likely to get tPA regardless of where they lived, the study showed.

What's the next phase of stroke treatment?

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I was fortunate enough to be in the right place, right time in 1998 - just two years after approval of clot-buster tissue plasminogen activator, also known as tPA or alteplase.

However, it's true that little has changed since then. Researchers have looked at different windows of time for the drug, which can quickly dissolve a clot to prevent further stroke damage, but new, safer and more effective drugs have not come to pass.

I have little right to complain about tPA, but I'm just one guy who benefited. It has its dangers, too. And while there are some good signs related to using devices to remove clots, much more research and work are needed to improve treatment and stroke outcomes.

You can read a recent article summarizing the need for the next phase in stroke treatment:

From biblical times to modern hospitals, timing can make all the difference

From Flickr by Sean MacEntee

Starting out in left field here. One of my favorite books in the Bible is Acts. Why? Because a lot of important events are happening quickly, and timing is critical. The order of events is part of a grand plan there.

I like timing things in life, too. I'm not as good as God with timing, but when my sequence of actions works, it gives me a great deal of satisfaction.

So, I'm interested in this recent story about how workflow processes can be a success, showing how clot busters can be delivered in an hour, even with an MRI:

Two centers -- one academic, one community -- that use MRI as part of an NIH study dropped their median DTN [Jeff's note: DTN stands for door-to-needle, or the time between the patient enters the hospital to the time of stroke treatment] time from 93 to 55 minutes after focusing their workflow processes, Amie Hsia, MD, of MedStar Washington Hospital Stroke Center, and colleagues reported online in Neurology.

Doesn't take a medical degree to save a life - know stroke signs

We've got a long way to go to prevent strokes, to find ways to maximize immediate stroke treatment, and to decrease the rate of disability for stroke survivors. Strokes kill too many people and disable too many people.

I, personally, don't have a hospital or a lab. You probably don't either. But we can make more people aware of early warning signs of stroke:

"Today, thanks to early detection, aggressive treatment and new intervention therapies, more stroke patients than ever are returning to normal life with limited to no disability," said Dr. Stanley Tuhrim, director of the Stroke Center at Mount Sinai Hospital in New York City.

Are hospital patients with stroke 'hiding in plain sight?'

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We're all told: Time is brain. And in a recent posting, even the newly developed tools to battle strokes work better when there's no delay.

So, it's a little distressing to find that time is still a problem - for patients who are already in a hospital. Even delays in imaging to determine best treatment. You'd think if the patient was already in the hospital, that would not be a problem.

But it is.

Read about recent research showing that imaging is delayed when a stroke strikes within a hospital:

Is something right happening in health care?

Something right might be happening.

In catching up on stroke-related news of late, I was reminded about a story showing that emergency departments are seeing fewer strokes and TIAs:

The rate of adult emergency department (ED) visits for ischemic stroke or TIA fell 35%, from 40 to 26 per 10,000 persons from 2001 to 2011 in the National Hospital Ambulatory Medical Care Survey (NHAMCS) data. The rates fell across age groups -- a relative 51% in the 55-to-74 range and 26% for those ages 75 and older, Anjali Talwalkar, MD, MPH, and Sayeedha Uddin, MD, MPH, both of the CDC's National Center for Health Statistics in Silver Spring, Md., reported in the March issue of NCHS Data Brief.

But among younger people who came to the ED for ischemic stroke or TIA, fewer were arriving by ambulance.

Strokes are generally preventable, with fairly common-sense diet, exercise and medication use leading those methods of prevention. I've put links under each of those categories, where you can read more about stroke prevention.

Stroke treatment is still vitally important, and improving stroke treatment through better medication, better therapy techniques and tools are key elements of stroke treatment. But preventing a stroke is the best treatment of all. So do what you can - the life you save could be your own.

Great story of personal, medical advances for stroke survivors

I like personal stories. I like stories about advances in stroke treatment and prevention.

So, I really enjoyed this one - a story from a London journalist who revisited the hospital that treated him 20 years ago.

I survived a stroke 20 years ago. Now a revolution in care is under way:

Treating even mild high blood pressure can pay off

I'm a big believer in watching blood pressure - it can be a sign of many, treatable problems. That includes stroke. In fact, high blood pressure is a leading cause of strokes.

Plus, it's an easy number to get checked - with consultation with a health professional, you can buy and learn to use a device to check it at home - and it involves no needles, scalpels or lab results.

Now, recent study shows a link between treating even mild high blood pressure pays off for stroke prevention:

Stroke falls in U.S. causes of death

In the news, you can find a New Year hint that stroke treatment seems to be working. Recently, the U.S. Centers for Disease Control and Prevention reported that stroke is dropping down the list of cause of death in the United States.

Read through this link how stroke falls one place to fifth leading cause of death in U.S.:

Commenting on the Centers for Disease Control and Prevention (CDC) report, the American Heart Association (AHA) hypothesize that the drop in deaths from stroke is due to advances in the treatment and prevention of stroke. In particular, the AHA note, there are more stroke centers now operating across the US, and there has also been an improvement in acute care of stroke.