Major Organizations Update Guidelines for Stroke Prevention
Every year more than 795,000 people in the United States have a stroke, which is a leading cause of long-term disability
In 2021, Barbara Jane, a 67-year-old New York City journalist, began having heart palpitations. They were intermittent and uncomfortable but not terribly frightening. Over the next two years, they started to become more frequent. Her cardiologist sent her to an electrophysiologist — a doctor who specializes in heart rhythm irregularity — who had her wear a Holter monitor for two weeks.
A woman talking to doctor before an MRI scan looking for symptoms of a stroke. Next Avenue
"It is crucial that we continue to increase awareness of stroke symptoms, and the importance of getting someone to a hospital as soon as possible," | Credit: Getty
"After a while, I began to feel like my heart was flopping around like a fish," she says. "There were days when my heart rate was as high as 180 beats a minute, when normal is supposed to be 60 to 100. You remember those old cartoons when someone's heart is jumping out of their chest? That's exactly what it felt like, and it was terrifying."
Jane was found to have premature atrial contractions, which raises the risk for atrial flutter and atrial fibrillation. A cardiac ablation, which involves destroying areas of heart tissue that are causing the irregular heartbeats, was done, followed by blood thinners prescribed to be taken for nine months after the procedure.
Jane is doing well now, walking 4 miles every other day along with resistance training twice a week, and is continuing to eat a healthy diet. Her cholesterol level is normal. Her physician wants her to wear a memory stick, used to store patient data, that is implanted under the skin, but she has so far resisted the idea, although she revisits it periodically.
"I don't want to look in the mirror and be reminded of what I went through. I'm not used to thinking about myself as having a heart condition, and although I'm continuing to follow the vast majority of my doctors' recommendations, I have made the choice not to worry about my stroke risk anymore," Jane says. Her doctor has told her, "You have an excellent heart, it's just that the electrical system in your heart is glitchy."
Types of Strokes
According to the CDC, every year more than 795,000 people in the United States have a stroke, which is a leading cause of long-term disability. Stroke statistics vary by race, age and ethnicity. There are two types of strokes, also known as cerebrovascular accidents, says Steven Shapiro, M.D., medical director of the comprehensive Stroke Center at Cooperman Barnabas Medical Center, an RWJBarnabas Health hospital. An ischemic stroke is caused by a blood clot or a piece of plaque blocking a blood vessel in your brain and is the type suffered by 87% of patients. A hemorrhagic stroke occurs when a blood vessel in the brain leaks or bursts, causing bleeding in the brain.
"Just as with a forest fire, the sooner we can stop the damage, the better the results, and, hopefully, speedy treatment can lessen the level of disability."
It's been 10 years since the American Stroke Association and the American Heart Association released guidelines for the primary prevention of stroke, which have been newly updated as of Oct. 21, 2024. Meant as a resource for health care providers, these revised recommendations are available online for the general public as well.
"It is crucial that we continue to increase awareness of stroke symptoms, and the importance of getting someone to a hospital as soon as possible," Shapiro says. "Although there is an increase in the window of time that stroke treatment can be effective, time is still of the essence, because time is brain. The longer it takes to open the blocked vessel, the more the viability of the tissue will be reduced."
Shapiro continues, "Just as with a forest fire, the sooner we can stop the damage, the better the results, and, hopefully, speedy treatment can lessen the level of disability."
To educate the public, the mnemonic BEFAST is used as a guide to detect stroke symptoms. It stands for:
B — Balance: sudden loss of balance or coordination
E — Eyes: sudden blurred or double vision
F — Face: drooping on one side of face
A — Arm: weakness or numbness in one arm
S — Speech: slurred speech, difficulty understanding or speaking
T — Time: time is of the essence; call 911 immediately
Understanding the New Guidelines
The new guidelines, based on current evidence for strategies to prevent strokes throughout the life cycle, reinforce the American Heart Association's Life Essentials 8 for enhancing cardiovascular and brain health. These include healthy diet, adequate physical activity, healthy weight, healthy sleep, no use of tobacco products, and maintaining healthy cholesterol, glucose and blood pressure levels. The importance of caring for individuals throughout their lifespan, including youth, is stressed. Major topics that are addressed include:
Patient assessment
Atherosclerosis
Special populations and sex-specific risk factors (transgender, pregnant, women with endometriosis and those who are menopausal)
Heart disease
Use of anticoagulants (blood thinners) and antiplatelet medications
The report also delves into other subjects including hormone usage, carotid artery blockages and GLP-1 receptor agonists such as Ozempic. The new report also underscores the importance of the primary care doctor. "We do not concentrate enough on primary prevention, which means an individual has not yet had a stroke," Shapiro says. "The primary care doctor is the central person who looks for and treats conditions that raise someone's stroke risk and marshals care when specialists are needed."
"The amount and degree to which we've been able to help stroke patients has just been remarkable."
The report also addresses, for the first time, social determinants of health, pointing out how systemic and structural racism and food insecurity can contribute to cardiovascular issues.
Four months after the release of the new guidelines, the annual International Stroke Conference, with over 4,500 attendees from more than 60 countries, was held in February in Los Angeles. According to Keith Churchwell, M.D., president of the American Heart Association, much progress has been made in the care of stroke patients "in ways that would have been science fiction a generation ago."
In presentations and poster sessions over the three-day span, the conference described the latest advances in stroke prevention, treatment and rehabilitation. Churchwell says, "I was struck by the degree of excitement not only in the panel members but in the audience itself. The amount and degree to which we've been able to help stroke patients has just been remarkable."
