A few years ago at a conference for heart disease survivors, two well-known cardiologists fielded questions about stroke. Drawing on decades of experience reviewing informed consent with patients about to undergo procedures, one of the cardiologists said neither risk of heart attack nor even dying gives patients or their families much pause. But mention stroke, he said, and the conversation changes.
The patients in the audience had questions about preventing stroke, recognizing stroke, treating stroke. Their questions, said the other cardiologist on the podium, were as insightful as those he received from some of his fellows-in-training. These heart patients wanted to know how science was pushing stroke care forward.
In this issue, we look at two therapies with the potential for reducing the devastating burden that stroke places on patients, their families and society. Our cover story dives into left atrial appendage (LAA) occlusion and the work physicians and hospitals are doing now so that once reimbursement questions are answered, they are ready to offer these procedures to atrial fibrillation patients who are at increased risk for stroke and aren’t able to take anticoagulants. In the right patients, when delivered by trained operators backed up by collaborative teams, LAA occlusion could prevent strokes.
Next we turn to efforts to treat strokes, suffered by more than 795,000 Americans each year. Our feature on acute stroke intervention using stent retrievers examines the opportunities these devices present to change treatment paradigms. While mechanical thrombectomy costs may be high, the potential quality-adjusted life year gains resulted in the intervention being cost effective in two analyses. To succeed, health systems will have to change: the availability of comprehensive stroke centers may need to be expanded, and hospitals may need to start thinking about door-to-reperfusion time as much as they did with door-to-balloon time for STEMI care.
Teamwork is central to intervening earlier and better, and changing the course of stroke treatment. The heart team model has taken off with valve therapies, and now it’s poised to be tweaked for each of these new approaches to tackling stroke. Which clinicians comprise and lead heart teams may be changing in the effort to improve stroke prevention and intervention, but the common denominator is still the patients and their families who, despite their many questions and awareness of stroke’s ramifications, aren’t as knowledgeable as they should be about the symptoms of stroke and when to seek help.