STROKE: Studies Find Lack Of Awareness

      Both the public and the medical community are not adequately knowledgeable about stroke, the third leading cause of death in America, according to several studies published in yesterday's Journal of the American Medical Association. One of the studies -- a telephone survey of the Cincinnati metropolitan area -- found that there are "major gaps in the public's knowledge of stroke" and that "[c]onsiderable education is needed" to increase public awareness. University of Cincinnati researchers, lead by Dr. Arthur Pancioli, found that only 57% of respondents could name at least one warning sign of stroke. Even more alarming, the respondents at greatest risk for stroke -- those over 75 years of age -- were even less aware about stroke warning signs and risk factors (Pancioli et al, JAMA, 4/22 issue). The Cincinnati Enquirer reports that the study "drew considerable response from medical experts nationwide." Dr. Fletcher McDowell, vice chair of the National Stroke Association, said the study shows there is "an overwhelming lack of awareness about stroke," underscoring "the importance of educating the public about the risk factors they can control through moderate lifestyle changes and medication" (Bonfield, 4/22).

Doctors Too
      In an accompanying editorial, JAMA's senior editors write that the public's lack of knowledge causes them to "delay seeking medical attention," thereby adding to the problem. Moreover, write Drs. Phil Fontanarosa and Margaret Winker, doctors often misdiagnose stroke victims when they arrive in the emergency room (4/22 issue). Another study in yesterday's JAMA found that doctors correctly interpreted computed tomography (CT) scans only 82% of the time. But the University of California at Los Angeles researchers maintain that in order to effectively detect signs of a stroke, doctors need to read the tests accurately 95% or 99% of the time (Schriger et al, 4/22 issue). Click here to view JAMA's table of contents.

Vicious Circle
      The Boston Globe reports that TPA, a recently approved drug that "could spare thousands of Americans each year from death and disability," is not being effectively utilized because of "public ignorance and lack of readiness among doctors." In a study published in Neurology, Wayne State University's Dr. Susan Fagan found that TPA treatment could "save more than $4 million for every 1,000 patients treated." However, the Globe notes that TPA must be administered within "three hours after symptoms begin." Taking into account time needed to get to the emergency room and for tests to be administered, "patients must recognize what is happening and call for help within 90 minutes or so after onset of symptoms." "Considering that there are tens of thousands of stroke patients who could be eligible for TPA, we are talking about a potential cost savings in excess of $100 million a year," said Dr. Michael Walker of the National Institute of Neurological Disorders and Stroke (Knox, 4/22). "The No. 1 reason people don't get treated is because they don't get there in time," said Pancioli. According to the American Heart Association, stroke kills 158,000 Americans per year and leaves more than 1 million disabled (AP/Washington Times, 4/22).