House passes stroke prevention legislation

Washington -- A decade ago, Lisa Deck rushed to a hospital emergency department because she had a severe headache and felt numb on her left side. Deck noticed a Stroke Awareness Month banner on the Washington, D.C., hospital's wall.

"I remember looking at that and saying, 'Wow, I have a lot of those symptoms,' " she said.

But Deck, then a 21-year-old American University senior, thought that only old men had strokes, which she believed killed people quickly. The treating physician attributed Deck's symptoms to the stress of graduating in one week. The doctor discharged her and told her to take aspirin.

Three days later, with her symptoms worsening, she went to a different hospital. After a CT scan and an MRI, she was diagnosed as having a stroke. Deck went on blood-thinning medication. She was later diagnosed with central nervous system vasculitis, a rare autoimmune disease.

Stroke treatments have advanced a great deal in the decade since Deck's incident, and awareness has improved, but both could stand more work, said Larry Goldstein, MD, director of the Stroke Center at Duke University and director of the American Heart Assn.'s Stroke Council.

A bill approved by the U.S. House late last month, the Stroke Treatment and Ongoing Prevention Act of 2007, aims to address those issues. It includes $95 million for training of health professionals, telehealth networks to connect stroke patients and physicians, a national database of treatments and outcomes, and a national awareness campaign. All are to be carried out between 2008 and 2012.

A Senate bill introduced late last month outlines similar programs and authorizes "such sums as necessary" for them. The AMA has yet to take a position on this bill but has supported similar measures in the past.

About 60% of stroke care is initially delivered by primary care physicians, Dr. Goldstein said. "This will hopefully help primary care physicians deliver the best possible care to their patients that may have cerebral vascular disease," he said.

Stroke is the third leading cause of death in the U.S., behind heart disease and cancer. About 700,000 Americans have strokes each year, and more than 160,000 of them die, said the Centers for Disease Control and Prevention.

There are many efforts to study and improve stroke care at the state level and more locally, Dr. Goldstein said. "But we're not necessarily learning well from what's going on in other similar areas," he said.

The national stroke registry has its roots in 2001, when Congress provided funding for CDC pilot projects in eight states to gather data on stroke treatment and outcomes. Four of those states -- Georgia, Illinois, Massachusetts and North Carolina -- began federally funded stroke registries in 2004. Both bills direct the secretary of Health and Human Services to expand that concept nationwide.

The measures also direct the secretary to create a stroke public awareness campaign. Only 17% of Americans recognize the major symptoms and know to call 911, according to "Prevention Works: CDC Strategies for a Heart-Healthy and Stroke-Free America," published in May 2006.

Deck, of course, is part of that 17%. The 31-year-old mother of one lives in Rockville, Md., and has volunteered with the American Stroke Assn. for the last five years. She conducts outreach to many children and young stroke survivors. Many people Deck meets are still surprised at how young a stroke survivor can be, she said.