ISC 16 WEDNESDAY NEWS TIPS

February 17, 2016 Categories: Scientific Conferences & Meetings, Stroke News

Tip Titles:

  • “Stroke camp” offers caregivers emotional support, physical relief and education
  • Bleeding stroke associated with onset of dementia
  • Getting out of the hospital bed for short periods soon after stroke has the potential to improve outcomes
  • Clot-busting drug may help stroke patients beyond standard treatment window or after “wake-up stroke”
  • Stroke survivors’ caregiving costs more time and money than previously estimated
  • Closing PFO “hole in the heart” may prevent strokes linked to this heart defect

Note: All Times are Pacific (PT). All tips are embargoed until the time of presentation or 3 p.m. PT/6 p.m. ET each day, whichever comes first.

Embargoed for 8 a.m. PT/11 a.m. ET – Abstract 27 (Room 152)

“Stroke camp” offers caregivers emotional support, physical relief and education

Stroke camp provides caregivers with much needed peer support, emotional relief and learning opportunities, according to research presented at the American Stroke Association’s International Stroke Conference 2016.

Depression, loneliness and social isolation are common among people who care for stroke survivors. The Retreat and Refresh Stroke Camp is a two-and-a-half-day experience, staffed by volunteer healthcare providers and therapists, which brings stroke survivors and caregivers together for education, recreation and support activities. Sixty-seven caregivers attended the camps from 2009 to 2015 and answered survey questions about caregiving and their camp experiences.

Researchers analyzed those surveys and found:

  • 80 percent of caregivers felt stroke impacted work and life. Of those, 64 percent noted the strain of having to change personal plans, 43 percent cited being confined to home and 40 percent were concerned with financial pressures.

  • 75 percent noted loss of time and freedom.

  • 50 percent indicated the survivor’s loss of the ability to communicate and 45 percent pointed to the loss of companionship as major strains.

  • 50 percent of caregivers felt overwhelmed/stressed/depressed upon returning home from the hospital.

  • Stroke camp helped the majority of the caregivers who attended. Seventy-nine percent indicated the camp experience made them feel less alone, 77 percent said it recharged them and 58 percent noted it educated them.

The long-term impact and cost-benefit of the camp still needs to be studied, researchers said.

Maureen Mathews, D.N.P., A.P.N., C.N.P., OSF Healthcare, Peoria, Illinois.

 

Embargoed for 8:45 a.m. PT/11:45 a.m. ET – Abstract 43 (Room 152)

Bleeding stroke associated with onset of dementia

Bleeding within the brain, or intracerebral hemorrhage, was associated with a high risk of developing dementia post stroke, according to research presented at the American Stroke Association’s International Stroke Conference 2016.

Intracerebral hemorrhage, which results from a weakened vessel that ruptures and bleeds into the brain, represents 13 percent of all strokes. Researchers studied how often and why dementia might occur after intracerebral hemorrhage by following a population of 218 intracerebral stroke patients, who were free of dementia in the first six months after stroke.

They found:

  • 20 percent had developed dementia at one year after stroke.

  • 63 patients developed new onset dementia during an average follow-up of 5.4 years.

  • Risk factors associated with a higher risk of dementia after intracerebral hemorrhage, included the location of the brain bleed, older age, history of a previous stroke or transient ischemic attack, higher stroke severity score and recurrent stroke during the follow-up.

  • Risk factors identified on brain imaging were particularly linked with a very frequent cause of bleeding strokes called cerebral amyloid angiopathy.

Doctors caring for stroke survivors should consider dementia risks, especially when risk factors are present, researchers said.

Solène Moulin, M.D., Lille University Hospital, Lille, France.

 

Embargoed for 2:30 p.m. PT/5:30 p.m. ET – Abstract 76 and Abstract 153 (Rooms 502B & 515A)

Getting out of the hospital bed for short periods soon after stroke has the potential to improve outcomes

In their aim to provide a guideline for healthcare providers about the timing, frequency and amount of in-hospital mobilization of stroke patients, researchers studied the care and recovery of more than 2,100 patients admitted to a hospital stroke unit, according to research presented at the American Stroke Association’s International Stroke Conference 2016.

About half of those patients received frequent, early and higher amounts of mobilization, starting within 24 hours of their stroke. The other half received usual care, which involved lower-dose, and early mobilization. The researchers followed up with those patients three months later.

In the first study (abstract 76), researchers found that 46 percent of the early, higher dose-mobilizers experienced a good outcome compared with just over half of those receiving usual care, so higher dose mobilizing didn’t improve outcome. Usual care shifted 28 minutes earlier each year with patients being encouraged to move out of bed sooner. The question of moving stroke patients out of bed earlier has been met with hesitation due to concern of harming the patient, but researchers found no overall differences in serious adverse effects. They also found that early, frequent out of bed activity helped prevent serious complications in those aged 65-80 years.

In another analysis (abstract 153), the researchers found that getting hospitalized stroke patients out of bed for frequent, but short bouts of movement helped increase the odds that they’ll regain independence three months after their stroke. In this analysis they found:

  • A consistent pattern of improved odds of favorable short-term stroke recovery with the use of more frequent out-of-bed sessions.

  • Increasing the amount of time spent mobilizing in each session didn’t work in the patients’ favor, with higher amounts of time actually reducing the odds of patients’ being independent at three months.

    Session frequency appears to be important, but too much too soon may interfere with recovery.

Julie Bernhardt, Ph.D., Florey Institute of Neuroscience and Mental Health, Austin Campus, Heidelberg Heights, Victoria, Australia.

Abstract 76 actual presentation time is 2:30 p.m. PT/5:30 p.m. ET, Wednesday, Feb. 17, 2016.

Abstract 153 actual presentation time is 9:45 a.m. PT/12:45 p.m. ET, Thursday, Feb. 18, 2016.

 

Embargoed for 2:30 p.m. PT/5:30 p.m. ET – Abstract 62 (Room 515B)

Clot-busting drug may help may help stroke patients beyond standard treatment window or after “wake-up stroke”

The clot-busting drug alteplase may help salvage brain tissue even when it is given hours beyond the three-hour window after stroke onset or to patients suffering wake-up strokes, according to research presented at the American Stroke Association’s International Stroke Conference 2016.

Alteplase is a tissue plasminogen activator (t-PA) which breaks up stroke-related blood clots. It is approved to treat patients who arrive at the emergency room within three to 4.5 hours of stroke onset but many patients get to the emergency room hours later and some have strokes while they’re sleeping, so it’s difficult to pinpoint when symptoms started.

Researchers studied 105 ischemic (clot-caused) wake-up stroke patients and patients whose strokes started 4.5 to 9 hours before treatment to determine whether salvageable brain tissue was still present. Wake-up stroke patients, in general, had more tissue loss from their strokes than non-wake-up stroke patients. However, both groups have a substantial amount of salvageable tissue, which is at risk of dying if blood flow is not restored promptly.

Researchers said that administering the clot-busting drug 4.5 to 9 hours after symptom onset or to those who woke up with stroke has the potential to be beneficial given the substantial presence of the therapeutic targets of viable tissue.

This is an ongoing study looking at whether administering alteplase to these patients’ leads to long-term health benefits, researchers said.

Henry Ma, F.R.A.C.P., Florey Neuroscience and Mental Health Institutes, Melbourne, Victoria, Australia.

 

Embargoed for 3 p.m. PT/6 p.m. ET – Poster W P299 (Hall H)

Stroke survivors’ caregiving costs more time and money than previously estimated

The average annual estimated cost for caregiving for an elderly stroke survivor is about $11,300, which translates to about $40 billion annually among all Medicare beneficiaries, according to research presented at the American Stroke Association’s International Stroke Conference 2016.

Researchers analyzed a large national study of Medicare beneficiaries, comparing caregiving between 892 stroke survivors and a similar group of Medicare beneficiaries, who had not had a stroke. Caregivers were defined as all people who helped with self-care, mobility or with household activities, which the care recipient could not do because of health or functioning.

On average, stroke survivors received about 22 hours of caregiving each week, which was about 10 hours more than the weekly amount of caregiving for those without stroke.

Previous research on caregiving for stroke survivors estimated that the average survivor received up to 16 hours a week hours of informal caregiving at a societal cost of as much as $26.8 billion a year. But these studies did not include activities, such as assistance with doctors’ visits, health insurance decisions, transportation or money matters (opening or closing accounts, for example).

Lesli Skolarus, M.D., University of Michigan, Ann Arbor, Michigan.

Actual presentation date and time is 6:15 p.m. PT/9:15 p.m. ET, Wednesday, Feb. 17, 2016.

 

Embargoed for 3 p.m. PT/6 p.m. ET – Poster W P422 (Hall H)

Closing PFO “hole in the heart” may prevent strokes linked to this heart defect

Stroke survivors who also have patent foramen ovale (PFO), a hole in the heart, could benefit from a device that closes the PFO to help prevent future strokes, according to research presented at the American Stroke Association’s International Stroke Conference 2016.

Researchers studied 980 stroke survivors, ages 18 to 60, who had strokes that were determined to be of unknown cause (cryptogenic) but had a PFO. A PFO results when a hole between the heart’s chambers does not close at birth. It is thought that blood clots from a vein may travel through the PFO, block an artery in the brain and cause a stroke. Researchers implanted a PFO closure device in half the patients and prescribed blood thinning medications to the other half to determine which treatment might be better for preventing subsequent strokes.

In a long-term follow-up, researchers found:

  • Forty-two patients had recurrent strokes, including 18 in the group that received the device and 24 in the medicine group.

  • 56 percent of the device group’s recurrent strokes were cryptogenic and the remainder were unrelated to their PFO.

  • 79 percent of the medication group’s recurrent strokes were cryptogenic.

  • The size and location of the recurrent strokes also tended to be different. Those without the device tended to have large strokes more often than those with the device, and they were more often on the edges of the brain than deep inside.

Researchers said the device can only prevent strokes related to PFO. PFO-related strokes tend not to have another cause, are larger and on the edge of the brain. There were fewer such strokes in the device group than in the medical group, lending support to the probability that the PFO device prevents PFO recurrences.

David E. Thaler, M.D., Ph.D., Tufts University School of Medicine, Boston, Massachusetts.

Actual presentation date and time is 6:15 p.m. PT/9:15 p.m. ET, Wednesday, Feb. 17, 2016.

Additional Resources:

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Statements and conclusions of study authors that are presented at American Stroke Association scientific meetings are solely those of the study authors and do not necessarily reflect association policy or position.  The association makes no representation or warranty as to their accuracy or reliability. The association receives funding primarily from individuals; foundations and corporations (including pharmaceutical, device manufacturers and other companies) also make donations and fund specific association programs and events.  The association has strict policies to prevent these relationships from influencing the science content.  Revenues from pharmaceutical and device corporations are available at www.heart.org/corporatefunding.

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