When I first see a patient, I ask the “chief complaint”. Doctors are taught to respond to disease. Our approach to stroke is the same. We have found that if we give medication to patients within three hours of the onset of symptoms, we can dramatically improve the long-term outcomes of more than 10% of those patients. And we can prevent further strokes with medications and other interventions in 30% of these post-stroke patients.
The striking point about these numbers is that for most patients, we struggle to have an impact. And that potential impact can be profound. More than 750,000 new or recurrent strokes occur in the U.S. each year. Stroke is the third leading cause of death. Every 45 seconds a stroke occurs, and every three minutes someone dies of a stroke. But perhaps more important, stroke is the leading cause of adult disability. If we try to do anything in healthcare, we try to prevent death and disability in our patients. When you combine these two endpoints, stroke may be the most serious consequence in medicine.
We need to emphasize the ounce of prevention. Stroke doctors must respond to all patients before they have stroke symptoms. These patients will not see the stroke doctor to provide the “chief complaint”. Public education is critical. If we target four stroke risk factors, namely high blood pressure, an abnormal rhythm in the heart called atrial fibrillation (which predisposes individuals to stroke), cigarette smoking, and excessive alcohol use, some epidemiologists have estimated that we could reduce stroke incidence by 75%. Some experts dispute the ability to isolate and add up these risk factors, maintaining the impact may be less. But even at 50%, the impact on the health of our society would be substantial. High blood pressure is certainly treatable. Anticoagulation (known as blood thinners) for atrial fibrillation requires detection and monitoring, but is easily treated. Expense can be kept to a minimum with many of these drugs. Cessation of cigarette smoking and excessive alcohol use are money-saving lifestyle changes. It is likely that all the money spent on these could pay for the anticoagulants and the blood pressure medicines noted. There are many things we cannot change. Genetics, some insulin dependent diabetes, and age play a role in our risk. But many risks besides those noted above are modifiable. Diabetes, particularly the “insulin resistant” type, obesity, cholesterol, sedentary lifestyle, and diet all may be important risks. See www.webmd.com/stroke/tc/stroke-prevention
Stroke doctors could spend a lifetime treating stroke patients. But patients themselves could truly have a greater impact than all of our stroke experts combined by preventing the first stroke. Go ahead. Make my day. Put me out of business.
—James Farrell, MD.
Dr. James Farrell is a Neurologist at the Crestview Hills office.
James P. Farrell, MD
Appts: (513) 612-111
Common risk factors for Stroke