- The Washington Times - Tuesday, February 5, 2008

Georgetown University researchers are leading a study to determine why lower-income or minority District residents do not receive the same care in preventing or treating a stroke as their wealthier counterparts. The National Institute of Neurological Disorders and Stroke (NINDS) recently awarded the $10 million cooperative research grant to study disparities in stroke care.

More than three-quarters of District residents have at least one risk factor for a stroke, and blacks (who make up more than 60 percent of the District’s population) are two times more likely than whites to have a stroke. That puts stroke high on the list of concerns for doctors who treat a large minority population, says Richard Benson, program director of NINDS’ office of Minority Health and Research.

“Stroke is the third most common cause of death in this country,” Dr. Benson says. “With changing demographics and an aging population, this a big concern. D.C. falls into the Southeastern region of the United States, which has the highest stroke rates in the country.”

A stroke occurs when the blood supply to part of the brain is suddenly interrupted — an ischemic stroke — or a blood vessel in the brain bursts, spilling blood into the spaces surrounding brain cells — a hemorrhagic stroke. Brain cells die when they don’t receive oxygen and nutrients from the blood or there is sudden bleeding into or around the brain.

The study will involve patients at more than 20 area hospitals, including Georgetown University Hospital, Howard University Hospital, George Washington University Hospital, Greater Southeast Community Hospital, Washington Hospital Center, Providence Hospital, Sibley Memorial Hospital, National Rehabilitation Hospital, Suburban Hospital, Johns Hopkins Bayview Medical Center, and Good Samaritan Hospital.

Other investigators involved with the project are located at Medstar Research Institute in Hyattsville, the University of Wisconsin, Johns Hopkins University, University of California at Los Angeles and the University of Michigan.

Chelsea Kidwell, associate professor of neurology at Georgetown University and director of stroke centers at Georgetown University Hospital and Washington Hospital Center, is the lead researcher on the project. She says “it makes a lot of sense for us to better understand stroke care in the District.”

“Here in the nation’s capital, there is a medically underserved population,” she says. “There is a high proportion of African-Americans, and stroke care is not well developed. Nationally, the disparity has not been properly addressed.”

The project, which began enrolling patients last month, has three parts:

m Project Aspire (Acute Stroke Program of Interventions Addressing Racial and Ethnic Disparities) will investigate whether a greater number of patients who have had ischemic strokes can be treated with intravenous tissue plasminogen activator (tPA) in D.C. hospitals.

Currently tPA, a clot-busting medication, is the only medication of its kind. It can eliminate the blood clot in certain stroke patients and, in turn, improve the outlook for recovery. However, tPA has a limited window to be effective; it must be administered within six hours of the stroke. The medication is used on less than 5 percent of stroke patients in the District, Dr. Kidwell says. The study will try to determine the barriers to usage.

“We need to educate the community as well as health care providers,” Dr. Benson says.

m Project Protect DC (Preventing Recurrence of Thromboembolic Events through Coordinated Treatment in the District of Columbia) will look at whether patient navigators — community health workers paired with stroke patients — can help patients adhere to at-home regimens aimed at preventing a second stroke.

About 25 percent of patients who recover from a stroke will have another one within five years, according to NINDS statistics.

“The patient navigator model has worked well in cancer but has not been tested in stroke,” Dr. Kidwell says. “If we can help these patients increase compliance with their medications and other preventive behaviors, we can have a significant public health impact in preventing recurrent strokes.”

Patients in this program will get follow-up care that goes well beyond the “given meds and go home,” that many patients receive, Dr. Benson says.

“Stroke navigators will visit patients at home,” he says. “They will find out whether they have a question for the doctor and whether they are complying with the doctor’s instructions and taking their medications. This may increase compliance.”

m Project Decipher (Differences in the Imaging of Primary Hemorrhage based on Ethnicity or Race), will address the finding that blacks are more likely to have chronic brain micro-bleeds, which can be a marker for risk of more serious cerebral hemorrhaging.

“African-Americans have a higher rate of micro-bleeds,” says Dr. Kidwell. “It is most likely due to uncontrolled hypertension, but we don’t know for sure. We are trying to understand the disease process so to better understand the cause and prevention.”

Researchers expect to have data on the study within five years, Dr. Kidwell says.

Stroke facts

• About 700,000 Americans have a stroke annually; about 160,000 die from stroke-related causes.

• Blacks are twice as likely as whites to have a stroke.

• Risk factors include age, high blood pressure, previous history of heart disease or stroke, diabetes and smoking.

• Knowing the signs of a stroke — and calling for medical help right away — can limit permanent damage or risk of death. Signs include numbness or weakness of face, arm or leg, especially on one side of the body; confusion or trouble speaking or understanding; trouble seeing in one or both eyes; trouble walking, dizziness, loss of balance or coordination; and sudden, severe headache with no known cause.

Source: National Institute of Neurological Disorders and Stroke

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