Optimal target blood pressure for the primary prevention of hemorrhagic stroke: a nationwide observational study

Well, WHERE IS THE PROTOCOL ON THIS LOCATED?

Optimal target blood pressure for the primary prevention of hemorrhagic stroke: a nationwide observational study

Hwan Seok Shim^‡ Jeong-Mee Park^†‡ Yong Jae Lee Young-Deok Kim Tackeun Kim Seung Pil Ban Jae Seung Bang O-Ki Kwon Chang Wan Oh Si Un Lee^*

• Department of Neurosurgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam-si, Republic of Korea

Background: There are few reports on the preventative value of intensive blood pressure (BP) management for stroke, especially hemorrhagic stroke (HS), after new criteria for hypertension (HTN) were announced by the American College of Cardiology/American Heart Association in 2017.

Aims: This study aimed to identify the optimal BP for the primary prevention of HS in a healthy population aged between 20 and 65 years.

Methods: We conducted a 10-year observational study on the risk of HS, subclassified as intracerebral hemorrhage (ICH) and subarachnoid hemorrhage (SAH) according to BP categories (e.g., low normal BP, high normal BP, elevated BP, stage 1 HTN, and stage 2 HTN) using the National Health Insurance Service Database.

Results: Out of 8,327,751 participants who underwent a health checkup in 2008, 949,550 were included in this study and observed from 2009 to 2018. The risk of ICH was significantly increased in men with stage 2 HTN {adjusted hazard ratio [aHR] 2.002 [95% confidence interval (CI) 1.203–3.332]} and in women with stage 1 HTN [aHR 2.021 (95% CI, 1.251–3.263)]. The risk of SAH was significantly increased in both men [aHR 1.637 (95% CI, 1.066–2.514)] and women [aHR 4.217 (95% CI, 2.648–6.715)] with stage 1 HTN. Additionally, the risk of HS was significantly increased in men with stage 2 HTN [aHR 3.034 (95% CI, 2.161–4.260)] and in women with stage 1 HTN [aHR 2.976 (95% CI, 2.222–3.986)].

Conclusion: To prevent primary HS, including ICH and SAH, BP management is recommended for adults under the age of 65 years with stage 1 HTN.

Introduction

The incidence and diagnosis rates of cerebrovascular diseases related to stroke are increasing as the population ages and diagnostic technology is developed (1–3). Accordingly, the demand for research on the primary or secondary prevention of stroke is also increasing. Among the modifiable risk factors for stroke, hypertension (HTN) is an important common factor in several studies (4). In 2017, the American College of Cardiology/American Heart Association (ACC/AHA) released an updated guideline with new criteria for HTN, defining stage 1 HTN as a systolic blood pressure (BP) of 130–139 mm Hg or a diastolic BP as 80–89 mm Hg (5).

However, although several studies have reported new diagnostic criteria for HTN that lower the incidence of various cardiovascular events (CVEs) (6–8), there are few helpful reports on the prevention of stroke. Some studies reported that intensive BP control prevents secondary stroke (3, 9, 10), but few studies reported a significant correlation with primary stroke prevention (8). Studies reporting that intensive BP control helps prevent primary stroke have limitations in that they include only patients with specific diseases, such as diabetes, or subgroup analysis, such as for hemorrhagic or ischemic stroke, was not conducted (9).

Therefore, we conducted a large-scale observational study on the risk of hemorrhagic stroke (HS), subclassified as subarachnoid hemorrhage (SAH) and intracerebral hemorrhage (ICH) according to BP based on the new diagnostic criteria for HTN in a healthy population using a nationwide cohort.

More at link.

Antisecretory Factor May Reduce ICP in Severe TBI—A Case Series

Would this work in hemorrhagic stroke? Reduce the pressure?  WHOM is your doctor and stroke hospital contacting to get that answered? Or will incompetence occur again by DOING NOTHING?

Antisecretory Factor May Reduce ICP in Severe TBI—A Case Series

David Cederberg^1*, Hans-Arne Hansson², Edward Visse¹ and Peter Siesjö¹

• ¹Department of Neurosurgery, Skane University Hospital, Lund, Sweden
• ²Institute of Biomedicine, University of Gothenburg, Gothenburg, Sweden

Traumatic brain injury (TBI) constitutes a global epidemic. Overall outcome is poor, with mortality ranging from 10 to 70% and significant long-term morbidity. Several experimental reports have claimed effect on traumatic edema, but all clinical trials have failed. Antisecretory factor, an endogenous protein, is commercially available as Salovum^®, which is classified as a medical food by the European Union and has been proven effective in experimental trauma models. It has, however, previously not been tested in humans with severe TBI. We hereby report a case series of five adult patients with severe TBI, treated with Salovum. The objective of the intervention was to evaluate safety and, if possible, its effect on intracranial pressure and outcome. Patients received 1 g Salovum per kilo of body weight divided into six doses per 24 h. Each dose was administered through the nasogastric tube. Patients were scheduled for 5 days of treatment with Salovum. Intracranial pressure was controlled in all patients. In three of five patients, intracranial pressure could be controlled with Salovum and deep sedation (no barbiturates), except during periods of gastroparesis. Five of five patients had a favorable short-term outcome, and four of five patients had a favorable long-term outcome. No toxicity was observed. We conclude that at least three of the five treated patients experienced an effect of Salovum with signs of reduction of intracranial pressure and signs of clinical benefit. In order to validate the potential of antisecretory factor in TBI, a prospective, randomized, double-blind, placebo-controlled trial with Salovum has been initiated. Primary outcome for the trial is 30-day mortality; secondary outcomes are treatment intensity level, intracranial pressure, and number of days at the neurointensive care unit.

Introduction

Traumatic brain injury (TBI) constitutes a global burden despite the fact that mortality and morbidity have been reduced in several countries during the last decades (1, 2). Advances in neurointensive care, cerebral monitoring, and neuroradiology have improved outcome for patients with severe TBI, but the results globally are still poor with a mortality ranging from 10 to 70% and significant long-term morbidity (3).

Traumatic brain injury encompasses several pathogenic mechanisms as primary mechanical injury and hemorrhage followed by secondary events such as vasospasm, inflammation, excitotoxic cell damage, and energy deprivation but also long-term progressive brain tissue degeneration. One common denominator in TBI is cerebral edema, which may cause raised intracranial pressure (ICP) and is a major factor responsible for mortality and morbidity in TBI (4). The pathophysiologic mechanisms of cerebral edema are, however, only partially known (5).

Although several experimental reports have claimed effect on traumatic cerebral edema, all clinical trials have failed (6).

Antisecretory factor (AF) is a 41-kDa endogenous protein proposed to possess both antisecretory and anti-inflammatory effects (7). The exact mechanism of AF is unknown, but it has been proposed to act by modulation of proteasomes, complement, and myeloid cells (8–10). A recent report shows that AF inhibits the NKCC1 ion pump; the latter also has been implicated in the evolution of edema in TBI (11, 12).

Salovum^® is an egg yolk powder enriched for AF and classified as food for specific medical purposes in the EU. Salovum has been used in clinical trials for gastroenteritis and Ménière inflammatory bowel disease, and no toxicity has been reported [Lantmännen Functional Foods AB Besöksadress: S:t Göransgatan 160, Stockholm, Sweden, (13)].

The functional part of AF has been synthesized within a 16-amino-acid peptide, AF16. AF16 and AF have shown effects against cerebral edema and increased ICP in models of herpes encephalitis and TBI (14, 15).

We hereby report the first five patients with severe TBI, treated with the AF-enriched dietary supplement Salovum with the aim to assess ICP control and clinical outcome.

More at link. 

A Tale of Two Strokes: Hemorrhagic Cases Getting Left Behind

But have you identified EXACTLY why they died? They didn't die from stroke, they died from a type of brain damage. If you don't know where and when you will never solve Hemorrhagic strokes.

Have you worked on solving these hemorrhage cascade of death problems?

• hemorrhage cascade of death (9 posts)

 

 

A Tale of Two Strokes: Hemorrhagic Cases Getting Left Behind

— "We've tried surgery, we've tried medications" -- and not much to show for it

by Crystal Phend, Senior Editor, MedPage Today February 21, 2020

LOS ANGELES -- Improvements over the past decades in ischemic stroke mortality haven't been mirrored by even a budge in hemorrhagic stroke prognosis, a population-based study from the Netherlands showed.
In the Rotterdam Study, ischemic stroke mortality rates dropped starting around 1998 for a relative 29% reduction from 1991-1998 to 2008-2015 (29 vs 11 per 100 person-years, P<0.01).
Hemorrhagic stroke mortality rates, though, stayed steady (30 vs 25 per 100 person-years, P=0.93), Reem Waziry, MD, PhD, of Harvard T.H. Chan School of Public Health in Boston, reported here at the International Stroke Conference and online in Stroke.
"It makes sense, given the amazing advances we've had in the treatment of ischemic stroke with tPA now 25 years old and endovascular therapy now 5 years old," even though most of these therapies have been aimed at reducing disability rather than mortality, commented Ralph Sacco, MD, chairman of neurology at the University of Miami and past president of the American Heart Association.
"We've had many more failures for hemorrhagic stroke," Sacco told MedPage Today. "We don't have any major breakthroughs. We've tried surgery, we've tried medications, and we have not been as successful in altering the course for hemorrhagic stroke."
There have been some positive developments in hemorrhagic stroke recently, with the STICH trial showing improved mortality with early surgical hematoma evacuation but the MISTIE III trial missing significance for a similar approach with minimally invasive surgery plus thrombolysis.
"Although, these interventions show promise in selected samples of patients in the setting of clinical trials, these advances are not yet reflected in the setting of the general population," Waziry's group wrote in the Stroke paper.
The study assessed time trends in survival after first-ever strokes among the 14,926 participants in the long-running prospective study of middle-age and older adults getting follow-up exams every 3 to 4 years. After excluding those with a past history of stroke or an unspecified stroke diagnosis during the study period, there were 162 first-ever hemorrhagic and 988 ischemic strokes recorded from 1991 through 2015.
Limitations included low power for subgroup analyses, exclusion of unspecified strokes, and a population of mainly elderly stroke survivors.

Disclosures

The researchers and Sacco disclosed no relevant relationships with industry.

Primary Source

Stroke

Source Reference: Waziry R, et al "Time Trends in Survival Following First Hemorrhagic or Ischemic Stroke Between 1991 and 2015 in the Rotterdam Study" Stroke 2020; DOI: 10.1161/STROKEAHA.119.027198.

Black, Hispanic people may have greater risk of second hemorrhagic stroke than whites

Then you didn't look hard enough.  Genetically Speaking, Race Doesn't Exist In Humans.

Black, Hispanic people may have greater risk of second hemorrhagic stroke than whites

Black and Hispanic people may be more likely to have another intracerebral hemorrhage or a stroke caused by bleeding in the brain, than white people, according to a study published in the June 6, 2018, online issue of Neurology^®, the medical journal of the American Academy of Neurology.

Hemorrhagic stroke makes up only 10 to 15 percent of all strokes, but it is the deadliest and most disabling type of stroke. Once people have had a first stroke of this kind, they are at high risk of having another one, which is often fatal.

"Previous studies have shown that black and Hispanic people are at greater risk of having a first bleeding stroke, but studies have not looked at ethnic and racial differences in recurrent intracerebral hemorrhage," said study author Alessandro Biffi, MD, of Massachusetts General Hospital in Boston and a member of the American Academy of Neurology. "Since controlling high blood pressure is the main method of preventing second strokes and we know that there are racial and ethnic differences in the prevalence of high blood pressure and its severity, we really wanted to investigate these differences."

For the study, researchers combined results from two studies of people who had an intracerebral hemorrhage, for a total of 2,291 people. Of those 1,121 were white, 529 black, 605 Hispanic and 36 of other race/ethnicity. The participants' blood pressure readings were taken at the start of the study and at least once every six months after that. A total of 41 participants had previously had an intracerebral hemorrhage before the one involved in this study.

The 1,532 people in one study were followed for a year after the stroke and during that time 23 people had another stroke, for a recurrence rate of 1.5 percent. The 759 people in the second study were followed for an average of about four years. During that time 75 people had another stroke, for a recurrence rate of 3.9 percent.

Related Stories

• Mice study shows beneficial effect of MANF treatment on reversal of stroke-induced behavioral deficits
• Prestroke and poststroke oral anticoagulation therapy in AF patients
• Synthetic cannabis use may increase risk of heart attack and stroke

Combining both studies, there were 26 second strokes among the 1,121 white people, or 1.7 percent, compared to 35 second strokes among the 529 black people, or 6.6 percent, and 37 among the 605 Hispanic people, or 6.1 percent. The researchers found that black people were more than twice as likely as white people to have another stroke and Hispanic people were about 70 percent more likely than whites to do so.

The average systolic blood pressure was higher for black and Hispanic people than for whites, with an average of 149 mmHg for black people, 146 mmHg for Hispanic people and 141 mmHg for white people. Systolic blood pressure of less than 120 mmHg is considered normal; pressure of 140 mmHg or more is considered high.

Once researchers adjusted the results for the blood pressure differences, they found that black people were still nearly twice as likely to have another stroke as white people and Hispanic people were about 50 percent more likely to have another stroke.

"The differences in blood pressure among these groups do not fully account for the differences in the risk of having another stroke," Biffi said. "More research is needed to determine the factors behind this disparity."

Limitations of the study include that the number of recurrent strokes was limited and that the study captured only long-term blood pressure changes, not day-to-day variations.​

Source:

https://www.aan.com/PressRoom/Home/PressRelease/1653

Drug to treat bleeding may benefit some stroke patients, study finds

How many decades will it take before your hospital implements this? Or works with researchers to further test it out?  Incompetency in action if not done within a year.
https://medicalxpress.com/print445672790.html
May 16, 2018 in Medicine & Health / Cardiology

Patients with stroke caused by bleeding on the brain (intracerebral haemorrhage) may benefit from receiving a drug currently used to treat blood loss from major trauma and bleeding after childbirth, an international trial has revealed.

The study, led by experts at The University of Nottingham and funded by the National Institute for Health Research (NIHR) Health Technology Assessment Programme, found that giving tranexamic acid (TXA) to people who had experienced intracerebral haemorrhage reduced the number of deaths in the early days following the stroke.

It also found that both the amount of bleeding in the brain and number of associated serious complications were lower in the patients who had received the TXA treatment.

However, the trial found no difference in the number of people who were left disabled or had died at three months after their stroke (the study's primary outcome). The researchers believe further study is needed on larger groups of patients to enable them to fully understand the potential benefits.

The research is published in the medical journal The Lancet and was presented at the 4th European Stroke Conference in Gothenburg, Sweden on 16th May.

Nikola Sprigg, Professor of Stroke Medicine at the Stroke Trials Unit in the University's Division of Clinical Neuroscience, led the trial. She said: "Tranexamic acid is cheap—costing less than £15 per patient—and widely available so has the potential for reducing death and disability across the world."

"While we failed to show significant benefits three months after stroke, the reduction in early deaths, amount of bleeding on the brain and serious complications are signs that this drug may be of benefit in the future. More trials are needed, particularly focusing on giving treatment as soon as possible after the start of bleeding in this emergency condition.

"TICH-2 cements the position of the NIHR and the UK as key players in the world of stroke research. A study of this scale would simply not have been possible without support of the NIHR infrastructure. Alongside the large stroke centres, the contribution made by the network of smaller sites across the UK has been crucial to the success of TICH-2."

Around 150,000 people in the UK suffer a stroke every year—the majority of these are ischaemic strokes caused by a blocked blood vessel on the brain which can be treated very successfully in many cases with the use of clot-busting drugs (thrombolysis) administered within 4.5 hours of the stroke.

However, 15 per cent of all strokes—affecting around 22,000 people every year—are caused by haemorrhagic stroke when a blood vessel in the brain bursts, leading to permanent damage. While all people with acute stroke benefit from treatment on a stroke unit, there is currently no specific treatment for haemorrhagic stroke and unfortunately many people affected will die within a few days. Those who do survive are often left with debilitating disabilities including paralysis and an inability to speak.

A previous small pilot study by The University of Nottingham and funded by both the university and the charity the Stroke Association, concluded that a larger study was needed to accurately assess the effectiveness of the drug tranexamic acid. The drug was chosen for the study after previous research showed that it was successful in stopping bleeding in people involved in road traffic accidents.

For the latest trial, people who were diagnosed as having had bleeding on the brain—confirmed by CT scan—were offered the chance to take part in the study. Where the person was too ill to decide, permission was asked of their family or close friends. Where no family were available a doctor unconnected with the study decided if the patient should take part.

The five-year TICH-2 trial recruited more than 2,000 patients from 124 hospitals in 12 countries between 2013 and 2017. They were randomly sorted into two patient groups—one received TXA within eight hours of their stroke and another was given a saline placebo. In the UK, more than 80 hospitals took part in the study with support from the NIHR clinical research network.

CT scans of the patients' brains were performed 24 hours after their stroke and their progress was monitored and measured at day two and day seven after their stroke. The final follow up was performed at 90 days.

The study revealed that TXA did not improve the outcome for patients after 90 days as there was no significant difference in the number of patients who had subsequently died or had been left with disabilities between the TXA and placebo groups at three months.

However, in the TXA group there were fewer deaths by day seven following the stroke and, at day two, fewer people on TXA experienced a worsening of the bleed on their brain and had smaller amounts of blood in the brain compared to their control group counterparts. Also, the number of patients who experienced associated serious complications (such as pneumonia and brain swelling) were lower in the patients who had received the TXA treatment compared to those who had control.

The trial also found evidence that TXA might be more effective in patients with lower blood pressure as those with blood pressure lower than 170 mmHg had a more favourable outcome that those with 170mmHg and above. Other studies have confirmed that the sooner TXA is given, the more effective it is, and ideally it needs to be given within less than 3 hours of bleeding onset. In this study only one third of patients were given treatment within 3 hours of stroke onset.

As a result, the researchers have highlighted the need for further studies to find out whether giving an earlier dose of TXA might be beneficial for patients.

More information: Nikola Sprigg et al, Tranexamic acid for hyperacute primary IntraCerebral Haemorrhage (TICH-2): an international randomised, placebo-controlled, phase 3 superiority trial, The Lancet (2018). DOI: 10.1016/S0140-6736(18)31033-X

Provided by University of Nottingham

"Drug to treat bleeding may benefit some stroke patients, study finds" May 16, 2018 https://medicalxpress.com/news/2018-05-drug-benefit-patients.html

Deadliest type of stroke seeing surge of new research

I expect nothing from this, they have no strategy to solve any of the problems in stroke. Their heads are so far up their asses they can't even see that everything in stroke is a failure. 
https://news.heart.org/deadliest-type-of-stroke-seeing-surge-of-new-research/

By AMERICAN HEART ASSOCIATION NEWS

Patricia Nelson was leaving a restaurant after dinner last June with friends when she started hearing wind blowing in her ear before she’d even stepped outside. “I just didn’t feel right,” said Nelson, a stroke rehabilitation nurse.

The 51-year-old from Atlanta knew something was wrong and asked her friend to drive her to the hospital. By the time they got there, Nelson’s right side had gone numb. Doctors discovered she was having a hemorrhagic stroke.

Most strokes are caused by a clot that cuts off blood flow to the brain. But about 13 percent are caused by a weakened blood vessel that ruptures and bleeds into the brain. These so-called hemorrhagic strokes are the deadliest and least treatable type.

The focus of stroke research tends to follow the statistics, with more attention on clot-caused ischemic stroke, said neurologist Dr. Richard Benson, associate medical director of the Comprehensive Stroke Center at Medstar Washington Hospital Center in Washington, D.C.

Just last month, however, the American Stroke Association received an $11.1 million donation from the Henrietta B. and Frederick H. Bugher Foundation to fund hemorrhagic stroke research.

And in the last decade, there’s been a surge of clinical studies for intracerebral hemorrhage, or ICH, the most common of the two types of hemorrhagic stroke. ICH is caused by bleeding in the brain when an artery bursts.

“More money should be placed on stroke research and campaigns to educate people about the risks of stroke,” Benson said. (NO,NO, NO; you need to solve stroke problems, not punt and do nothing you blithering idiot)

Most recently, research has focused on prevention and the immediate management of ICH.

On the prevention side, high blood pressure — the most common cause of ICH — gets a lot of attention. Other causes include trauma, infection, tumors, blood vessel malformations and a degenerative condition known as cerebral amyloid angiopathy.

High blood pressure is more prevalent among African-Americans, who also are more likely to have diabetes and face higher obesity rates. All of these factors increase the risk of stroke.

Patricia Nelson had a hemorrhagic stroke last summer. (Photo courtesy of Patricia Nelson)

Nelson, who is African-American, thinks stress may have caused her blood pressure to rise without her realizing it. She didn’t have any other traditional risk factors for stroke.

“About two months before the stroke, I had a new job, new marriage and my car was broken into,” said Nelson.

Nelson’s blood pressure was dangerously high at the time of her stroke: 240 over 150. A blood pressure of less than 120 over 80 is what’s considered normal, according to blood pressure guidelines. Although blood in the brain can cause blood pressure to rise, Nelson’s blood pressure had likely been elevated for some time prior to her stroke.

“I know I’m very lucky,” she said.

The first few hours after bleeding begins are crucial. Within three hours, about one-third of ICH patients experience significant increased bleeding, which can cause neurological deterioration and even death. Current treatments include blood pressure management, medication and emergency surgery.

Aggressive medical care helps hemorrhagic stroke patients, but there’s less known about early surgical or medical treatments that decrease the rates of death and disability, said Dr. Steven Greenberg, a neurologist and director of the Hemorrhagic Stroke Research Program at Massachusetts General Hospital in Boston and an author of the AHA’s 2015 guidelines for treating ICH.

The role of invasive brain surgery in sensitive ICH patients remains controversial. A 2013 study confirmed earlier findings that ICH patients don’t benefit from surgery to remove hematomas to reduce bleeding and disability. Now, a trial called SWITCH is examining if surgery can reduce intracranial pressure and benefit ICH patients.

Other researchers are studying minimally invasive surgery as an alternative, like in the soon-to-be-completed MISTIE trial that’s examining whether minimally invasive endoscopic surgery plus a clot-dissolving drug called alteplase can safely lessen disability in ICH patients.

“If we can identify those at risk and offer treatment options to reduce that risk, then we can improve outcomes,” Greenberg said.

Sometimes, bleeding in the brain can be caused by blood-thinning medicines and until recently, there were limited options to reverse that excessive bleeding. One of the oldest oral anticoagulants, warfarin, can be reversed with Vitamin K. But newer anticoagulants did not have a reversal agent until 2015, when a drug called idarucizumab, marketed under the brand name Praxbind, was approved in emergency situations to reverse the effects of dabigatran, a blood thinner sold under the name Pradaxa to treat conditions such as atrial fibrillation. Trials for other reversal drugs are ongoing.

“We have some exciting things going on in stroke,” Benson said. (What the fuck are they? I see nothing.)

If you have questions or comments about this story, please email editor@heart.org.

The American Stroke Association receives $11.1 million gift from The Henrietta B. and Frederick H. Bugher Foundation to fund targeted research network in hemorrhagic stroke

You'll have to ask your doctor if ANY stroke interventions/protocols came out of the 4 earlier gifts from the Bugher Foundation.  The answer to that will tell you if this one will provide ANYTHING for survivors.
https://newsroom.heart.org/news/the-american-stroke-association-receives-11-1-million-gift-from-the-henrietta-b-and-frederick-h-bugher-foundation-to-fund-targeted-research-network-in-hemorrhagic-stroke

February 01, 2018 Categories: Program News

DALLAS, February 1, 2018 — The American Heart Association/American Stroke Association (AHA/ASA), the world’s leading voluntary health organization devoted to fighting cardiovascular disease and stroke, announces its fifth major philanthropic gift from the Henrietta B. and Frederick H. Bugher Foundation. With its latest gift, the Bugher Foundation will invest more than $11.1 million to fund the creation of a new targeted research network in hemorrhagic stroke, a specific type of stroke that occurs when a weakened blood vessel ruptures. The announcement was made at the Association’s International Stroke Conference in Los Angeles, California. Together, all forms of stroke currently comprise the fifth leading cause of all deaths in the United States.
To date, the foundation has invested more than $48 million in the AHA/ASA over the course of three decades, often in previously under-funded research areas. The distinctive and long-standing relationship between the foundation and the AHA/ASA continues with the development of the new ASA-Bugher Foundation Centers of Excellence in Hemorrhagic Stroke. There is a demonstrated gap in the scientific understanding of the multiple causes of this type of stroke, as well as how these serious events can best be prevented and treated. Hemorrhagic stroke currently accounts for approximately 15 percent of all stroke cases every year and these episodes have a fatality rate of nearly 50 percent in some studies. Because of the severity of this type of stroke, more than 100,000 people a year will die following a hemorrhagic stroke; especially if they do not have immediate access to highly trained medical centers who have neurosurgery expertise available.
“Since 1984, the AHA/ASA and the Bugher Foundation have collaborated to take calculated risks and fund areas of science where there is real need; areas of science that others have often ignored. Over the years, we have built a legacy of scientific excellence that has pushed boundaries and saved lives,” said Nancy Brown, CEO of the American Heart Association/American Stroke Association. “I’m thrilled to embark on our latest collaborative initiative -- new Centers of Excellence in Hemorrhagic Stroke that will put patients at the center of research in support of bold advances, while inspiring and training the next generation of interdisciplinary stroke researchers.”
The ASA-Bugher Centers of Excellence in Hemorrhagic Stroke will employ core collaborative research, training and science. Project investigators and their fellows will build a strong network, and share their work broadly so that the scientific community at large can benefit.
Precision medicine and data analysis will also play a key role in the research process. Specific components will include:

• Between three and five Centers of Excellence, engaging in up to three innovative research projects each, designed to make breakthroughs in prevention and/or treatment of hemorrhagic stroke;
• A centralized training structure, designing activities and engagement for fellows recruited by the Centers;
• An oversight advisory group of stroke thought-leaders to guide and oversee Center operations and to encourage approaches to specific, collaborative research questions;
• Open data sharing between projects and the greater research community using the AHA Precision Medicine Platform™, a state-of-the-art discovery portal, where researchers and physicians can quickly access and share information, collaborate on research and use precision medicine to treat cardiovascular disease and stroke;(This platform just proves that the AHA/ASA is not for stroke survivors at all)
• Development of a patient-focused hemorrhagic stroke cohort for integration into the AHA’s My Research Legacy™ initiative, a platform where people can sign up to share health, genetic and lifestyle data, to help researchers in their quest to end multiple forms of heart disease and stroke at the earliest possible time.

As part of the My Research Legacy™ component of this initiative, the American Heart Association is currently reaching out to engage survivors and families of those affected by hemorrhagic stroke.
An open application process for scientists interested in applying for funding as a part of this exciting research network will be announced in late 2019.
"The blueprint for the ASA-Bugher Centers of Excellence in Hemorrhagic Stroke stands on the shoulders of our previous four collaborations with the American Heart Association/American Stroke Association,” said Bryan Adams, trustee of the Bugher Foundation. "We are proud and honored to be part of increasing focus on an area of stroke research that deserves more attention.”
To donate and/or to fund specific programs and events visit www.heart.org/giving.  For more information about stroke, visit http://www.strokeassociation.org/.

###