ARTICLE IN BRIEF
A new campaign — jointly sponsored by the AAN, the ASA, and the ACEP — aims to improve stroke detection and early treatment.
In March, the AAN, the American Stroke Association (ASA), and the American College of Emergency Physicians (ACEP) launched a new campaign to promote stroke awareness. Leaders of a media tour included celebrity spokesperson Morgan Fairchild, an actress and stroke caregiver, and Diana Fite, MD, an emergency physician and stroke survivor, who appeared on more than 30 television and radio interviews to talk about how to recognize the five warning signs of stroke and the vital importance of early treatment.
The Stroke Collaborative, a joint initiative involving the three organizations, formed the “Give Me 5 for Stroke: Walk, Talk, Reach, See, Feel” campaign in response to studies published in 2007 that found that much of the public misreads stroke symptoms or delays treatment. The campaign introduced a new checklist of symptoms, and urges people to call 911 at the first sign of a stroke (See “Five Short Words to Stroke Detection”).
The project has been in the works for the past year, and additional information and materials collaboratively developed for the stroke professional team will be distributed by the AAN, ASA, ACEP, and made available at other professional national meetings soon, according to Rod Larson, AAN Deputy Executive Director.
An important component of the national “Give Me 5 for Stroke” campaign is a Web site at www.giveme5forstroke.org. New resources for stroke physicians and material for patients and caregivers will be added to the site in the near future, according to the AAN. The Web site also contains links to each of the three groups' Web sites for stroke tools and information.
Morgan Fairchild, who helped her mother survive a series of strokes that led to her death in 1999, was chosen as spokesperson because the campaign is particularly targeting women baby boomers. “They are caring for aging parents at risk for stroke, are also at risk for stroke themselves, and (as women) tend to be the health manager for the family,” said Wendy Segrest, director of operations at the American Stroke Association (a division of the American Heart Association). Additionally, research shows that women account for almost 70 percent of the deaths from stroke, and that the rate of strokes in middle-aged women has tripled.
Marilyn M. Rymer, MD, medical director of the Saint Luke's Brain and Stroke Institute in Kansas City, MO, and professor of medicine at the University of Missouri-Kansas City School of Medicine, is an AAN member of the Joint Member Advisory Group and worked with fellow members Jeffrey A. Switzer, DO, and David Wang, MD, to develop the professional resources component of the campaign. She noted that a unified message from all three groups — all are central to an effective stroke team response — to their members and the public would “be a very powerful force to improve stroke treatment and outcomes.”
Capitalizing on the celebrity of Fairchild is an effective method of communicating stroke awareness to the public, she said, emphasizing the necessity of getting to the hospital for treatment immediately.
Jeffrey A. Switzer, DO, assistant professor of vascular neurology at the Medical College of Georgia, noted that there have been disagreements among physicians regarding aspects of acute stroke management, particularly the use of IV tissue plasminogen activator (tPA). But, he said, “the hope was for the collaboration to emphasize concepts supported by all three organizations,” including to urge stroke symptom awareness, call 911, and get to the emergency department. The campaign also aimed to “develop a consensus of ‘best practices’ to help clinicians and hospitals improve acute stroke care on a local level,” develop a written patient and family education sheet describing the diagnosis and treatments for acute stroke, and create the Give Me 5 for Stroke Web site for stroke education.
“The AAN and ASA support the use of tPA in eligible patients because the evidence is overwhelming that treatment with tPA improves outcomes for stroke. Like all aggressive therapies, tPA may cause serious side effects, including cerebral hemorrhage,” Dr. Rymer said, but the benefits outweigh the risks.
Dr. Switzer noted that often emergency physicians — who don't always use tPA — cite the lack of support from neurologists in their community in acute stroke management as a reason for not treating acute stroke patients with tPA. Many physicians feel comfortable working in teams, and the absence of a neurologist can decrease comfort level, said Segrest.
Dr. Rymer added that “some emergency physicians are rightly reluctant to use tPA without the backup from a physician with expertise in the acute management of stroke.”
Dr. Switzer continued, “Efforts to improve neurologist involvement in acute stroke care, whether by improving reimbursement to neurologists for their time and energy or by using telemedicine systems to extend specialty to underserved communities, will likely increase tPA use and decrease disability from stroke.”
ACEP member Hubert Mickel, MD, an attending physician at the Johns Hopkins Bayview Medical Center, said that his institution has a stroke team and that the emergency physicians and neurologists collaborate well in providing tPA care as expeditiously as possible.
The Give Me 5 for Stroke campaign “presents concisely the deficits that may occur in a stroke and makes every effort to convince the individual with these symptoms to seek care as quickly as possible,” Dr. Mickel said. “Stroke usually does not present with pain, so many people wait to see if the symptoms go away. However, then it may be too late for tPA!”
While it is still a little too early to gauge the project's success, the feedback so far has been positive and the Give Me 5 for Stroke checklist has been shown to be more memorable than previously used stroke sign acronyms, experts agreed. The organizations have pledged their full endorsement, and experts believe the campaign will make a difference.
MORE ON TPA AND STROKE
Neurology Today has covered controversies and research surrounding the use of tPA in numerous articles, including these, in the past year (see neurotodayonline.com):
- “tPA Does More Than Dissolve Clots, New Study Finds, With Therapeutic Implications for Other Brain Disorders,” March 6, 2008.
- “Ten Years after FDA Approval, US Hospitals Slow to Adopt tPA for Ischemic Strokes,” May 1, 2007.
- “Mild Stroke Patients Best Treated with tPA,” March 21, 2006.