Research on education and awareness at the community level aims to cut disparities in stroke care.
EDNA Wooten somehow stopped her car when her stroke hit. Then her grown daughter ignored her slurred protests and raced her to the hospital – just in time for a drug to dissolve the blood clot that had caused her stroke.
Wooten was lucky. Too few stroke sufferers get that clot-busting treatment, especially black and Hispanic patients who are at the highest risk of having a stroke, and also may be particularly hesitant to seek fast care. New research is targeting those underserved populations to better spread the word that “time is brain” – the faster you move, the more brain you save.
“We basically scare people so much about stroke, it motivates them to denial,” says University of Michigan researcher Dr Lewis Morganstern, an expert on stroke disparities.
“What we haven’t done a good job of, is telling people there is an effective treatment, that people are in control of their own destiny.”
That was the message stroke educator Shauna St Clair of Georgetown University took to a
A St John Ambulance Malaysia volunteer answering a call at the control centre in Kuala Lumpur. Hesitation to call emergency services while you are having a stroke means more brain damage. senior centre in a predominantly black neighbourhood in Washington DC last week, as part of a project funded by the US National Institutes of Health (NIH). Most strokes are like a clogged pipe, St Clair explained. Break up the clog, and blood can resume feeding the starving brain cells on the other side, like what happened when Wooten, 61, was treated at a nearby hospital.
“Damaged brain cells we can fix. That’s why we want you to get treatment as soon as possible,” St Clair told the rapt group. “If they stay damaged, they die.”
About 795,000 Americans have a stroke every year. It is the nation’s leading cause of disability and the number three killer.
Symptoms include sudden numbness or weakness in the face, arm or leg, especially on one side; sudden trouble speaking, understanding speech, seeing or walking; and a sudden extremely severe headache.
While some strokes are caused by bleeding in the brain, the vast majority are ischemic strokes – the clot kind that the drug TPA (tissue plasminogen activator) can help treat, but only if it is given within a few hours of the first symptom.
Yet 14 years after TPA hit the market, overall only about 5% of US patients get it.
That is due partly to problems within the US health care system, and partly because only about a third of stroke sufferers get to the hospital in time for testing to tell if they are good candidates for it.
Everyone needs to know to act fast if they experience or witness stroke symptoms. But the new research comes because black Americans have strokes at twice the rate of whites, and are more likely to die. Hispanics are at an increased risk of stroke as well. Worse, both populations tend to have strokes at much younger ages than whites.
Georgetown researchers tracked ischemic strokes for a year in Washington DC, and found black patients received TPA less often than whites, in part because of slower hospital arrival, despite community surveys that found widespread knowledge about stroke symptoms.
“No, you can’t wait to see if your symptoms go away,” says Dr Chelsea Kidwell, a Georgetown neurologist who heads the project.
“No, you should not call your relative or friend. You’ve got to call 911.”
The findings echo a major study that Dr Morganstern leads in Corpus Christi, Texas, where MexicanAmericans were 40% less likely than whites to call 911 for treatment of a stroke. The disconnect is not surprising, says NIH National Institute of Neurological Disorders and Stroke deputy director Dr Walter Koroshetz. The most common mistake among all populations when feeling a stroke symptom is to take a rest.
Adding to the confusion are socalled ministrokes – a TIA or transient ischemic attack – in which an artery is blocked for a few minutes, but suffers no permanent damage.
It is a warning sign, however, that a major stroke may be imminent, which prompt care to treat risk factors like high blood pressure might avert.
Other studies have found that half of those who have had a TIA never tell a health provider.
It takes community-specific research to learn what act-fast messages work, Dr Morganstern says.
His Corpus Christi project recently taught middle-school students to call 911 if they witness someone having stroke symptoms. He also gave them homework assignments to teach their parents, thus reaching a hard-to-target population.
The project is also designing ways that local Roman Catholic churches can help with stroke education.
In Washington DC, Dr Kidwell is working with ambulance companies to have their units bypass the closest hospital for one of three certified stroke centres – hospitals with 24hour special capabilities to give TPA.
The community education will target not only seniors, but younger people who may witness a stroke – like the woman who told St Clair she had noticed her mother leaving church looking drunk, a loss of balance caused by a stroke.
It also will stress happy endings such as Wooten’s. She slept off a TIA two weeks earlier and credits her daughter’s love of TV hospital shows for recognising the major stroke.
About an hour after getting the clot-buster, “it was like it never happened,” says Wooten, who says her only lingering problem is a slight shake when her right hand holds something heavy.
“I’m driving my car, I’m messing with my grandkids. Thank God, I’m doing ok.” – AP