Top Tips to Avoid a Stroke
'Preventable' Strokes Are Most Treatable
But most 'would not be showing up to begin with' if basic prevention were followed.
By Salynn Boyles, MedPage Today
Medically Reviewed by F. Perry Wilson, MD, MSCE
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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.
Among them, 207 patients (75.5 percent) exhibited some degree of stroke preventability (score of 1 or higher), and 71 patients (25.9 percent) had scores of 4 or higher, indicating that the stroke was highly preventable, Mark Fisher, MD, of the University of California Irvine Medical Center, and colleagues reported online inJAMA Neurology.
Of the highly-preventable group, 29.6 percent were treated with intravenous or intra-arterial acute stroke therapy. By contrast that rate was only 19.4 percent (13 of 67 patients) with a score of 0 considered not preventable and 14.0 percent (19 of 136 patients) in the low-preventability group with scores of 1 to 3 on the scale.
"Our data suggest that the difficulties faced by patients with acute stroke extend far beyond the rather narrow period of emergency stroke treatment," Fisher's group wrote.
"If what could be characterized as a more holistic approach to the problem of stroke is taken, the result is a vast expansion of the window of intervention to include the very stroke prevention efforts that appear to be lacking in so many patients with hyperacute stroke."
In an interview withMedPage Today, Fisher said the stroke prevention message is getting lost with the increased emphasis on early stroke treatment and on educating the public about recognizing stroke symptoms.
"There are huge public health efforts to get acute stroke patients to hospitals quicker, so they can receive effective treatments," he said. "What is frustrating is that most of these people should not be showing up in hospital emergency rooms to begin with."
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Fischer said clinicians -- especially primary care physicians -- need to make sure their patients are on the appropriate preventive medications. He added that public education efforts need to emphasize stroke prevention along with stroke recognition.
"The level of education at the community level about stroke prevention is inadequate," he said. "Our message to the public shouldn't just be, 'Call 9-1-1 if you have these symptoms," because the strokes necessitating those 9-1-1 calls are all too often very preventable."
He noted that while stroke treatment times are improving nationwide as more hospitals receive stroke center certifications, patient follow-up is still not emphasized to the extent that it should be.
"Stroke prevention is a marathon, not a sprint," he said. "What happens in the hospital is the sprint side of it, but we also have to recognize that preventing recurrent stroke is a lifelong process that doesn't end with discharge."
In their study, Fisher and colleagues used variables easily determined at the onset of stroke to develop their 10-point preventability score, with a focus on the effectiveness of hypertension treatment (0 to 2 points), hyperlipidemia treatment (0 to 2 points) and atrial fibrillation (0 to 4 points), as well as use of antithrombotic treatments for known prior cardiovascular disease (0 to 2 points).
Severity of stroke, as determined by the National Institutes of Health Stroke Scale score, did not predict stroke preventability in the study.
The researchers acknowledged that the study design had several "significant limitations," noting that their definition of preventability was potentially flawed.
"Our definition of preventability is arbitrary to some extent, we have not included lifestyle factors, and we have not addressed the complexities inherent in patients with coexisting ischemic and hemorrhagic cerebrovascular disease (mixed cerebrovascular disease). However, our focus on physician-dependent treatment factors adds to the ease of determining preventability scores," they wrote.
Despite the study limitations, Fisher said the finding raise important questions about whether resources for treating acute stroke are being directed toward patients whose strokes are the most preventable.
"Education of community physicians and the public about stroke prevention needs to be a higher priority," he noted.
From the American Heart Association:
The research was supported by a grant from the the National Institutes of Health.
Fisher reported serving on clinical events committees for Covidien, as well as serving as a principal investigator for AstraZeneca and receiving grant support from Otsuka Pharmaceuticals.
Video: Stroke - Causes, Symptoms and Treatment Options
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