By RON WINSLOW
Stroke, until recently the third leading cause of death in the U.S., has dropped back to fourth place, reflecting a host of gradual improvements in preventing and treating the disease.
The change isn't a result of major advances in new medicines or devices. Instead, medical experts cite improvements in controlling people's risk factors such as high blood pressure and smoking. They also point to the increase in recent years in the number of designated stroke centers and emergency rooms that are specially equipped for stroke patients.
A recent study underlines the incremental progress being made. Researchers in California found that treating stroke patients with cholesterol-lowering drugs called statins throughout a hospital stay substantially improved survival rates and increased the chances of patients being discharged to their home instead of to a nursing home.
"In the country as a whole, there has been a dramatic reduction in stroke-related mortality in the last few years," said Larry Goldstein, director of the Duke Stroke Center at Duke University Medical Center, Durham, N.C. "We're learning more and more about preventing stroke."
In the 10 years ending in 2008, the latest data available, the death rate from stroke, as a percentage of the population, fell 35% while the actual number of deaths per year declined nearly 20%, according to the American Heart Association.
Still, the toll from stroke is daunting. Nearly 800,000 people in the U.S. suffer a stroke each year, according to the American Heart Association. Only cardiovascular disease, cancer and respiratory infections such as pneumonia kill more people. About seven million Americans are currently living after suffering a stroke, which is one of the main causes of disability. About half of these patients have weakness on one side of their bodies; 30% are unable to walk without assistance; and 26% are in nursing homes, according to data from the Framingham Heart Study. Treatment costs for stroke total nearly $20 billion a year.
The failure to recognize or act quickly on stroke symptoms is one of the biggest barriers to improved care. The only approved drug to treat acute stroke is the clot-buster known as tPA, which has to be given within three hours of the onset of symptoms, though guidelines allow up to 4 hours in some cases. Only about 5% of stroke patients arrive at the hospital in time to get tPA, experts estimate.
Designated stroke centers, which are certified by the Joint Commission, a hospital regulatory body, typically have systems for emergency-room doctors to notify an established stroke team of a possible patient and to streamline the path to imaging tests that can confirm if a stroke has taken place. The systems also maintain communication with ambulance crews to speed a patient's time to treatment, said Ralph Sacco, head of neurology at University of Miami Miller School of Medicine.
Statin drugsknown mostly for their ability to lower LDL, or bad cholesterol, to reduce risk of heart attackare also an important weapon for preventing and treating stroke. Current guidelines, for instance, call for patients hospitalized for stroke to be discharged with a prescription for a statin. But the guidelines say little about whether to use the medicines while a patient is hospitalized for stroke.
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Dr. Larry Goldstein comments: Small changes in treatment keep stroke patients alive