Education is Key to Stroke Treatment

An aggressive education campaign about stroke symptoms and timely medical treatment can greatly increase a patient’s chance of receiving an effective, but uncommonly used clot-busting stroke therapy.

Dr. Lewis Morgenstern, associate professor of neurology and epidemiology at The University of Texas Medical School at Houston, said that in a study of five rural counties in East Texas, use of intravenous tissue plasminogen activator, or t-PA, was more than four times the national average when educational interventions were applied.

Nationally, only 1 to 2 percent of patients typically receive t-PA, compared to 8.65 percent in Dr. Morgenstern’s study group.

The results of the research, funded by the TLL Temple Foundation, were published recently in Stroke: Journal of the American Heart Association.

"We chose rural areas because there are more obstacles to getting fast medical treatment than in metropolitan areas," Dr. Morgenstern said. "The people are more spread out. The hospitals are farther away. What we were able to show is that even with these obstacles, more patients received t-PA in the communities where we were doing the education. We feel that if we were this successful in rural communities, it would be remarkably successful anywhere."

In Angelina, Nacogdoches and Shelby counties, brochures, posters, billboards and radio and television public service announcements were printed and broadcast about stroke symptoms and treatments.

In addition, residents were educated about symptoms of stroke, which include sudden weakness or numbness of one side of the body, difficulty speaking or understanding, inability to walk, facial drooping and clumsiness. They learned that stroke patients need to get to a hospital quickly because the clot-busting drug can only be used within three hours of the onset of symptoms.

Once residents completed training, they educated their own coworkers and neighbors about the importance of calling 9-1-1 if they recognize that someone has signs of stroke. Community leaders who had suffered strokes and recovered after receiving t-PA participated in the education campaign. Health care providers also were educated about stroke symptoms, the effectiveness of t-PA and how to administer the drug.

When UT-Houston researchers began the study in 1998, only about 2 percent of patients with ischemic stroke received t-PA in Angelina, Nacogdoches and Shelby counties. In 2000, after the education campaign, that number rose to almost 9 percent. In contrast, in Jefferson and Orange counties, where there was no public education, health care providers administered the clot-busting drug to less than 1 percent of stroke patients.

Dr. Morgenstern, co-director of the UT-Houston Stroke Team, said this strategy could have significant public health implications for reducing disability in the United States, because if t-PA is properly administered, it can reduce severity of symptoms or alleviate symptoms all together. Currently, stroke is the nation’s No. 3 killer and the leading cause of severe, long-term disability.

"There are more than 600,000 strokes each year in the United States. An increase in treatment by even 6.5 percent would mean 39,000 more treatments. The bottom line is that we have this very effective drug to treat stroke, but very few patients receive it," Dr. Morgenstern said. "If we can educate the public about stroke and really convince them that they have control over their destiny if they get to the hospital fast enough, more people will benefit from this treatment."

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