An Update From the American Stroke Association and the Stroke Council
2021; Lippincott Williams & Wilkins; Volume: 52; Issue: 6 Linguagem: Inglês
10.1161/strokeaha.121.034827
ISSN1524-4628
AutoresLee H. Schwamm, Peter D. Panagos, Stephanie M. Mohl,
Tópico(s)Stroke Rehabilitation and Recovery
ResumoHomeStrokeVol. 52, No. 6An Update From the American Stroke Association and the Stroke Council Free AccessResearch ArticlePDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyRedditDiggEmail Jump toFree AccessResearch ArticlePDF/EPUBAn Update From the American Stroke Association and the Stroke Council Lee H. Schwamm, MD Peter D. Panagos, MD Stephanie M. MohlBA Lee H. SchwammLee H. Schwamm Correspondence to: Lee H. Schwamm, MD, Massachusetts General Hospital, Wang Ambulatory Care Center Suite 720, 55 Fruit St, Boston, MA 02114. Email E-mail Address: [email protected] https://orcid.org/0000-0003-0592-9145 Massachusetts General Hospital, Boston (L.H.S.). , Peter D. PanagosPeter D. Panagos https://orcid.org/0000-0003-1464-0167 Massachusetts General Hospital, Boston (L.H.S.). , Stephanie M. MohlStephanie M. Mohl https://orcid.org/0000-0003-1265-2172 American Stroke Association division of the American Heart Association, Dallas, TX (S.M.M.). Originally published13 May 2021https://doi.org/10.1161/STROKEAHA.121.034827Stroke. 2021;52:e269–e271This past year has been a challenging one for the world, the United States, and for the stroke community. In the United States, although official mortality data for 2020 is not yet available, cerebrovascular disease is expected to temporarily fall from the fifth to the sixth leading cause of death—not because of advances in stroke prevention and treatment but rather because deaths from coronavirus disease 2019 (COVID-19) will displace it as a leading cause of death. Not only is COVID-19 impacting the delivery of stroke care and brain function in ways that we are still learning about, but it has also highlighted persistent structural health inequities among people of color. Similarly, the senseless killings of George Floyd, Breonna Taylor, and many others by police and the more recent mass murder of primarily a group of Asian women in Atlanta have heightened awareness of the broad impact that racism, including structural racism, has on health and well-being.1In response to this crisis, the American Stroke Association (ASA) division of the American Heart Association (AHA) and the AHA/ASA Stroke Council shifted their focus in 2020 and modified the organization's strategic goals. The Stroke Council commissions and develops science-based guidelines and publications, meetings, professional education, and training programs. The ASA works to translate this stroke-related science into effective initiatives, programs, and resources for patients and caregivers, the public, health care professionals and facilities, and policymakers, with support from the Stroke Council. Early in the pandemic, the Stroke Council responded by issuing emergency guidance to help US stroke centers adapt their stroke system of care to ensure the highest quality of care possible.2The AHA/ASA responded to the pandemic by creating its new COVID-19 Cardiovascular Disease registry, powered by the Get With The Guidelines hospital quality improvement program, and by adding COVID-19-related fields to its Get With The Guidelines-Stroke registry. As of April 5, 2021, the COVID-19 Cardiovascular Disease registry contained >42 000 records of patients hospitalized with COVID-19 at nearly 170 hospitals,3 and Get With The Guidelines-Stroke reported outcomes for 41 971 patients with acute ischemic stroke, of whom 1143 had a diagnosis of COVID-19.4 The AHA/ASA also has awarded $2 million in scientific research funding to begin to study the effect of COVID-19 on the brain and cardiovascular system.5To support public education, the ASA developed a series of 5 podcasts for stroke survivors and their caregivers with information and tips to help them learn about the disease, stay emotionally well and physically active, and maintain their rehabilitation regimen while staying home and practicing social distancing. The AHA/ASA has launched a series of COVID-19 "Take Action" campaigns: (1) Don't Die of Doubt, reminds patients that calling 911 is essential in a stroke or other cardiovascular emergency and that the hospital is the safest place to be, (2) "It's Up to You" informs individuals on the importance of getting the COVID-19 vaccine to stay healthy and safe, and (3) "Doctor, It's Been Too Long," encourages individuals to make an appointment to visit their doctor during the pandemic. Finally, the ASA is working to develop a digital self-management tool for stroke survivors and their caregivers. The COVID-19 pandemic has further highlighted the importance of medical tools to support greater patient engagement in health care delivery and self-care.In recognition that the COVID-19 pandemic has significantly changed the health care landscape for years to come, the AHA and ASA have also re-focused their strategic priorities. The association's Board of Directors approved a new 2024 Health Impact goal that places health equity front and center and is anchored by the belief that "every person deserves the opportunity for a full, healthy life. As champions for health equity, by 2024, the American Heart Association will advance cardiovascular health for all, including identifying and removing barriers to health care access and quality."6The ASA will continue to focus on preventing, treating, and beating stroke but with a focus on initiatives specifically intended to help reduce disparities in cerebrovascular care and outcomes. The ASA is working to delay and prevent stroke and improve brain health by partnering with national organizations and focusing on improved blood pressure control among people of color. More specifically, research has shown that providing Black men with blood pressure screenings and promoting physician follow-up during their barbershop visits can improve hypertension control by 8.8% compared with a control group.7 In an effort to scale and expand availability of these barbershop and beauty salon interventions, ASA is collaborating with Live Chair (https://www.livechair.com) to train barbers and beauty salon stylists to be health advocates and support them through the Live Chair Health app to engage, assess, and provide referrals for hypertension treatment of their at-risk minority clients.This year's American Stroke Month campaign in May will be focused on preventing stroke, particularly among Black and Latina women with uncontrolled hypertension. The campaign will highlight the unique risks that women face for stroke, encourage them to self-monitor their blood pressure, and to learn the warning signs of stroke. In June, ASA will be turning our attention to preventing stroke among men and also among members of the lesbian, gay, bisexual, transgender, and queer or questioning community.The ASA continues its focus on reducing disability from stroke by speeding up delivery of care and increasing the percentage of patients who receive reperfusion treatment, particularly in underserved rural and inner-city areas. Encouragingly, recent data from GTWG-Stroke presented at the International Stroke Conference 2021 has demonstrated a narrowing gap in racial inequities for patients receiving endovascular thrombectomy in the United States, but there is still considerable work to be accomplished.8 Improving prehospital stroke transport protocols within stroke systems of care can help eradicate disparities, especially if they are customized to local communities, as outlined in the recently published "Recommendations for Regional Stroke Destination Plans in Rural, Suburban, and Urban Communities From the Prehospital Stroke System of Care Consensus Conference."9The ASA and the Stroke Council are also committed to supporting young and diverse investigators. The Stroke Council offers a number of awards to support travel costs for junior and minority researchers to stroke-related meetings, as well as a research scholarship for medical or graduate-level students studying cerebrovascular disease. In addition, recent efforts to promote diversity among speakers, moderators and content at the International Stroke Conference, and editors and content at the journal Stroke have increased the opportunities for women, international members, and others underrepresented in American academic medicine.We encourage all stroke professionals to partner with the ASA and the Stroke Council in our efforts to be a relentless force for a world of longer, healthier lives by staying up to date with the latest stroke resources and by helping to disseminate this information to your colleagues, patients, and the public. To learn more about the work of the Stroke Council, we encourage you to visit us at http://professional.heart.org/strokecouncil. To learn more about the work of the ASA, please visit us at www.stroke.org/professionals.Nonstandard Abbreviations and AcronymsAHAAmerican Heart AssociationASAAmerican Stroke AssociationCOVID-19coronavirus disease 2019Disclosures Dr Schwamm discloses that he serves as the chair of the American Stroke Association Advisory Committee. Dr Schwamm receives significant research support from the National Institutes of Health (NIH), modest research support from the Patient-Centered Outcomes Research Institute, Genentech, and Medtronic. He receives personal compensation for his service on medical advisory boards for Genentech, LifeImage, Medtronic, and the Massachusetts Department of Public Health and for serving on data safety monitoring committees for Penumbra and Diffusion Pharma. Dr Panagos serves as the chair of the American Heart Association/American Stroke Association (ASA) Stroke Council. Dr Panagos receives significant research support from the NIH/NINDS. S.M. Mohl is the vice president of the American Stroke Association.FootnotesFor Sources of Funding and Disclosures, see page e270.Correspondence to: Lee H. Schwamm, MD, Massachusetts General Hospital, Wang Ambulatory Care Center Suite 720, 55 Fruit St, Boston, MA 02114. Email [email protected]harvard.eduReferences1. Churchwell K, Elkind MS, Benjamin RM, Carson AP, Chang EK, Lawrence W, Mills A, Odom TM, Rodriguez CJ, Rodriguez F, et al.. Call to action: structural racism as a fundamental driver of health disparities: a presidential advisory from the American Heart Association.Circulation. 2020; 142:e454–e468. doi: 10.1161/CIR.0000000000000936LinkGoogle Scholar2. AHA/ASA Stroke Council Leadership. Temporary Emergency Guidance to US Stroke Centers During the Coronavirus Disease 2019 (COVID-19) pandemic: on behalf of the American Heart Association/American Stroke Association Stroke Council Leadership.Stroke. 2020; 51:1910–1912. doi: 10.1161/STROKEAHA.120.030023Google Scholar3. American Heart Association Website. American Heart Association COVID-19 CVD Registry Powered by Get With The Guidelines | American Heart Association.Accessed April 6, 2021.Google Scholar4. Srivastava PK, Zhang S, Xian Y, Xu H, Rutan C, Alger HM, Walchok J, Williams J, De Lemos JA, Decker-Palmer MR, et al.. Acute Ischemic Stroke in patients with COVID-19: an analysis from get with the guidelines-stroke.Stroke. 2021; 52:1826–1829. doi: 10.1161/STROKEAHA.121.034301LinkGoogle Scholar5. AHA Press Release: 12 Scientific Teams Redefining Fast-Tracked Heart and Brain Health Research Related to COVID-19.April 30, 2020. Accessed April 6, 2021. https://newsroom.heart.org/news/12-scientific-teams-redefining-fast-tracked-heart-and-brain-health-research-related-to-covid-19?utm_campaign=covid-19&utm_source=phd&utm_medium=link&utm_content=phd-05-01-20Google Scholar6. American Heart Association Website.2024 Health Equity Impact Goal | American Heart Association. Accessed April 6, 2021.Google Scholar7. Bufalino VJ, Bleser WK, Singletary EA, Granger BB, O'Brien EC, Elkind MS, Lopez MH, Saunders RS, McClellan MB, Brown N, et al.. Frontiers of upstream stroke prevention and reduced stroke inequity through predicting, preventing, and managing hypertension and atrial fibrillation: a call to action from the Value in Healthcare Initiative's Predict & Prevent Learning Collaborative.Circ Cardiovasc Qual Outcomes. 2020; 13:e006780. doi: 10.1161/CIRCOUTCOMES.120.006780LinkGoogle Scholar8. Sheriff F, Xu H, Cruz-Flores S, Fonarow GC, Matsouaka R, Xian Y, Reeves M, Smith EE, Saver JL, Schwamm LH. National Temporal Trends in Endovascular Therapy (EVT) Utilization and Outcomes According to Race and Ethnicity: Findings From Get With the Guidelines (GWTG)-Stroke. International Stroke Conference 2021.March 19, 2021. International Stroke Conference 2021 OnDemand™ Extended Access | AHA (heart.org). Accessed April 6, 2021.Google Scholar9. Jauch EC, Schwamm LH, Panagos PD, Barbazzeni JB, Dickson R, Dunne R, Foley J, Fraser JF, Lassers G, Martin-Gill C, et al.. Recommendations for regional stroke destination plans in rural, suburban, and urban communities from the prehospital stroke system of care consensus conference: a consensus statement from the American Academy of Neurology, American Heart Association/American Stroke Association, American Society of Neuroradiology, National Association of EMS Physicians, National Association of State EMS Officials, Society of NeuroInterventional Surgery, and Society of Vascular and Interventional Neurology: Endorsed by the Neurocritical Care Society.Stroke. 2021; 52:e133–e152. doi: 10.1161/STROKEAHA.120.033228LinkGoogle Scholar Previous Back to top Next FiguresReferencesRelatedDetails June 2021Vol 52, Issue 6Article InformationMetrics Download: 112 © 2021 American Heart Association, Inc.https://doi.org/10.1161/STROKEAHA.121.034827PMID: 33980043 Originally publishedMay 13, 2021 KeywordsbrainCOVID-19goalracismregistriesPDF download SubjectsSocial Determinants of HealthCerebrovascular Disease/Stroke
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