Managing Stroke Risk and Raising Awareness

May 2022 is National Stroke Awareness Month.

We're examining the causes of stroke, highlighting prevention tips, exploring the warning signs, and sharing helpful resources for healthcare professionals caring for stroke patients.

Every 40 seconds, someone in the United States suffers a stroke. This adds up to more than 795,000 strokes each year and accounts for roughly 1 out of every 19 American deaths. Tragically, up to 80% of these strokes are preventable.

Heart disease and stroke remain leading causes of death, disability, and healthcare costs in the United States. Over the past 30 years, the rate of stroke overall in the U.S. has continued to increase, according to a systematic analysis published this past fall.

Despite the troubling trends, however, there is room for hope. Nurses, therapists, and other healthcare professionals are uniquely positioned to help educate their patients about the risk of cardiovascular diseases (CVD) and encourage healthy habits that may lessen the impact of heart attack and stroke.

A critical window

When it comes to treating a stroke, time is of the essence. "The closer to the start of the stroke that someone receives a clot buster or mechanical removal of a clot, when appropriate, the more likely they are to have a normal outcome, return to home, and return to work," said Brian Silver, MD, FRCPC, FAHA, FAAN, FANA, chair and professor in neuroscience research at the University of Massachusetts Chan Medical School.

The location of the stroke in the brain can also impact treatment. "Strokes in the back part of the brain, known as posterior circulation strokes, are less likely to be diagnosed early because they may mimic other conditions, such as vertigo due to inner ear problems, sudden hearing loss in one ear, and blurred/double vision," Silver said.

Related: Functional Gains in Stroke Recovery using Therapeutic Exercise

Signs and symptoms

A simple mnemonic device from the American Stroke Association (ASA) may help healthcare professionals identify stroke symptoms quickly.

The mnemonic reminds healthcare professionals to B.E. F.A.S.T.:

• B: Balance. Is the patient suddenly having trouble with their balance or coordination?
• E: Eyes. Is the patient experiencing sudden blurred or double vision, or a sudden loss of vision in one or both eyes without pain?
• F: Face Drooping (or Facial Numbness). If a stroke is suspected, ask the patient to smile. A sudden uneven smile is cause for concern.
• A: Arm Weakness. Ask the patient to raise both arms. If an arm drifts downward, this may be a sign of stroke.
• S: Speech Difficulty. Slurred speech is a concern.
• T: Time to call 911.

The lingering impact of the pandemic

Unsurprisingly, the COVID-19 pandemic has exacerbated what was already a dangerous condition in vulnerable populations. According to research presented at the ASA's International Stroke Conference 2022, the risk of stroke among older adults diagnosed with COVID-19 is most severe within the first three days.

Following the first three days post-diagnosis, risk quickly declines, but remains 60% higher between days 4-7, and was 44% higher between days 8-14.

The lowest risk occurred after 15-28 days, when risk was assessed at 9% higher. There were no differences in stroke risk related to sex, or race, and ethnicity, according to the study.

Another study examining acute ischemic stroke released in April found that risk of stroke is more than twice as high for COVID-19 patients in general when compared to people of the same age, sex, and ethnicity.

In August 2021, a study based in Sweden reported the risk of stroke was 3-6 times higher for COVID-19 patients (average age of 48) and remained high for at least one month.

Managing stroke risk

While not all strokes are preventable, healthy habits can lead to a significantly decreased risk of stroke or other CVD. Those habits may include:

• Eating a diet rich in fresh fruits and vegetables and low in saturated fats, trans fat, and cholesterol as well is low in salt and high in fiber.
• Maintaining a healthy weight for one's height, is usually calculated via body mass index (BMI). Resources for weight assessment and the BMI relationship are available online through the CDC.
• Regular physical activity. For adults, the recommendation is 2.5 hours of moderate-intensity aerobic physical activity, such as a brisk walk, each week. Children and teens should get one hour of physical activity every day.
• Avoiding tobacco and alcohol.
• Regular cholesterol testing, preferably at least once every five years.
• Management of high blood pressure and other chronic medical conditions. This may involve follow-up communication with patients to monitor their progress and ensure that a care plan is being followed.
• Keeping an open dialogue with patients regarding medications and other concerns they may have about their cardiovascular health.

Other risk factors

Unfortunately, some causes of stroke are outside a patient's control, such as age, genetics, gender, and ethnicity.

The likelihood of stroke increases with age for both males and females, though women are more likely to die from a stroke. Factors that may increase stroke risks for women include pregnancy, history of preeclampsia/eclampsia or gestational diabetes, oral contraceptive use, and post-menopausal hormone therapy.

"Women are also more likely than men to present with non-traditional symptoms, such as sudden confusion," said Silver. "A sudden change in mental function should be evaluated for possible stroke."

A history of previous strokes also increases a patient's risk of future strokes. According to the CDC, a patient who has had one or more transient ischemic attacks are almost 10 times more likely to have a stroke than someone of the same age and sex who hasn't.

To stay up-to-date on the latest stroke and CVD research, we invite you to visit the American Stroke Association's Stroke Resource Library, or explore in-depth CE courses on these and other critical topics for healthcare professionals at HomeCEUConnection.com.