And something like this news will allow our stroke medical professionals and leadership to once again ignore the hard work of addressing all the problems in stroke.
My stroke was completely preventable if the doctor treating my dad for his 80% blockage of his carotid artery had told him to contact any children and have their arteries tested. Which nothing in here would address.
http://www.medpagetoday.com/Cardiology/Strokes/55099
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%) exhibited some degree of stroke preventability (score of 1 or higher), and 71 patients (25.9%) 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 in JAMA Neurology.
Of the highly-preventable group, 29.6% were treated with intravenous
or intra-arterial acute stroke therapy. By contrast that rate was only
19.4% (13 of 67 patients) with a score of 0 considered not preventable
and 14.0% (19 of 136 patients) in the low-preventability group with
scores of 1 to 3 on the scale (P=0.03).
"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 with MedPage 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."
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.
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