Recurrent Stroke Victims' Stories Illustrate Need for New Treatment Guidelines

Heart-rending cases like that of Steven Spence — a 68-year-old man who suffered a second stroke in his home only hours after being treated for his first one in a hospital — underscore the urgent need to create new standards for in-hospital and transition-of-care treatment of stroke patients, advocated by neurological health and patient safety experts.

Mr. Spence was discharged from hospital on the same day he was admitted for stroke treatment in the hospital's emergency room. Within hours after he was sent home, Mr. Spence suffered a second stroke. His family called for an ambulance, and he was rushed to a different hospital for treatment. The recurrent stroke left Mr. Spence unable to speak, and his family members were unsure if he could recognize them.

Stroke is a leading cause of death and disability in the U.S., where approximately one in every four of the nearly 800,000 strokes that occur each year is recurrent.1

"The tragic irony of recurrent stroke is that it is predictable – and often preventable," says Deborah V. Summers, stroke program coordinator at Saint Luke's Health System's Marion Bloch Neuroscience Institute (formerly Saint Luke’s Brain and Stroke Institute) in Kansas City, Mo.

In a statement she co-authored for the American Heart Association, 2 Ms. Summers cites evidence that shows the health of approximately one in three stroke patients will deteriorate within 24 hours after suffering a stroke. "This points to the critical need for intensive continuous monitoring of all stroke patients," she wrote. "In those first 24 hours, ongoing monitoring of blood pressure, temperature, oxygenation and blood glucose is essential to rapidly assessing and protecting the health and safety of stroke patients."

Equally important is for hospitals to provide nurses with intensive training and education in neurological assessment and in critical monitoring of bleeding complications, Ms. Summers says.

Training nursing and providing continuous monitoring are among several recommendations likely to emerge from a group of leading neurological health and patient safety experts who are now examining ways to reduce death and disability among stroke victims. Assembled by the Physician-Patient Alliance for Health & Safety, the stroke patient safety group will ultimately compile a stroke VTE safety recommendations to help guide and remind healthcare providers in the in-hospital and transition-of-care treatment of stroke patients. With input from leading physicians and patient-safety experts, PPAHS has created similar recommendations and checklists aimed at improving the safety of patients receiving patient-controlled analgesia and preventing venous thromboembolism in maternal patients.

"We are especially focused on reducing the rate of recurrent stroke, which — as stories like Mr. Spence's tragically illustrate — is simply unacceptable,” says Mark Reiter, MD, CEO of Emergency Excellence, who serves as president of the American Academy of Emergency Medicine and residency director of emergency medicine at The University of Tennessee at Murfreesboro and is a member of the stroke patient safety group. "Considering the wealth of research, knowledge and advanced technology that is now available to providers, we are confident that incidences of secondary stroke can — and should be — dramatically reduced."

For example, Dr. Reiter pointed to a study of nearly 3,000 stroke patients in the United Kingdom comparing the efficacy and safety of intermittent pneumatic compression therapy against routine care (hydration, aspirin, graduated compression stockings and/or anticoagulants). Sponsored by the University of Edinburgh and the National Health Service, the randomized study found a 29-percent reduction in life-threatening deep vein thrombosis — and a 14 percent reduction in overall mortality — for patients receiving IPC therapy.

"Numbers like these validate exactly what our group seeks to accomplish: to create new standards that will save lives and improve the well-being of literally thousands of stroke patients each year," Dr. Reiter says.

1 Furie, K. et al, “Guidelines for the Prevention of Stroke in Patients With Stroke or Transient Ischemic Attack: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association” Stroke. 2011;42:227-276.

2 Summers, D, “A Comprehensive Overview of Nursing and Interdisciplinary Care of the Acute Ischemic Stroke Patient, A Scientific Statement From the American Heart Association” Stroke. 2009;40:2911-2944.

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