Atlanta Hyperbaric treats stroke patients and we always look carefully at new stroke research for ways to help our patients. From time to time reports come out that raise important practical questions and today I want to discuss two of them.
The strain of caring for a disabled spouse appears to increase the risk of stroke. Psychosocial stress is a widely studied risk factor in stroke and coronary artery disease. Researchers in Tampa took a look at data from the REGARDS (REasons for Geographic and Racial Differences in Stroke) study, a continuing epidemiological assessment of stroke and coronary heart disease incidence and mortality in a large national sample of adults over age 45. The researchers reported about 12% of Americans older than 45 have “family caregiving responsibilities.”
Of the more than 30,000 participants in the study, the researchers found 767 who lived with and cared for a disabled spouse and had no history of stroke or coronary heart disease. Based on interviews and home visits, the researchers divided the participants into those reporting high, some, or no strain associated with caregiving. The researchers reported high care-giving strain associated with a 13.62% 10-year risk of stroke, which was 23% higher than the estimated stroke risk of 11.06% for caregivers reporting no strain. African-American men with high care-giving stress had an estimated 10-year stroke risk of 26.95%, white men had a 10-year risk of about 15% and white and African-American women had risks between 10% and 12%.
The authors discuss with candor some of the limitations of their study, but the general conclusion-someone who found great strain in caring for a disabled spouse had an increased stroke risk-seems valid enough. The association, in my view, should be pointed out to patients’ families so that they can find ways to help relieve the strain, if possible.
The second study comes out of Sweden and looks at stroke-patient compliance with their medications to prevent future strokes. To avoid errors in self-reporting, these researchers linked data from the national stroke registry with that of the national prescribed-drug registry. The analysis involved 21,077 stroke survivors, whose clinical records were compared with prescription data from July 1, 2005 to Oct. 31, 2008. About 50% of stroke survivors stopped taking stroke-preventing meds within two years of hospital discharge. A fourth of patients had stopped blood-pressure meds at two years, and almost half had discontinued their statins, e.g. Lipitor, Crestor etc. More than half had quit prescribed anticoagulants, e.g.,Coumadin, and more than a third had stopped taking antiplatelet medication, e.g., aspirin, Plavix.
Physicians grapple with medication adherence all the time. Compliance with hyperbaric oxygen therapy here at Atlanta Hyperbaric was a difficult problem during 2009, with almost every single patient who dropped out stating that he was missing too much work and feared losing his job in this recession-wracked economy. In fact, Atlanta Hyperbaric is going to start offering expanded hours for our patients to do our share to help out. The best thing we as physicians can do about medication compliance, in my opinion, is to take the time to explain to patients how important the medications are to their well being. It seems simple enough, but I believe most physicians are unable or unwilling to spend this extra time.