Mount Sinai Researchers Find That Latino Stroke Survivors More Likely to Experience Depression
Research on stroke prevention, recovery, and disparities presented at the International Stroke Conference.
Findings in post-stroke depression, gender and race disparities, and novel recurrent stroke interventions will be presented by researchers from the Icahn School of Medicine at Mount Sinai at the American Stroke Association’s International Stroke Conference 2013. The meeting will take place February 6-8, 2013 in Honolulu.
Currently, 30 percent of stroke survivors will suffer a second stroke, making secondary stroke prevention a priority. Mount Sinai has implemented a new trial called the Prevent Recurrence of All Inner-city Strokes through Education (PRAISE), in which they enrolled 600 stroke survivors from Harlem and the South Bronx and assigned them to peer-led groups to assess how they aided in stroke recovery and secondary stroke prevention.
- Latinos Have Higher Incidence of Depression Post-Stroke than White Americans
As part of the PRAISE trial, researchers evaluated the prevalence of post-stroke depression in the cohort. They used a patient health questionnaire, demographics, comorbidities, and socioeconomic status to establish a depression severity ranking, and found that 30 percent of participants were depressed. Latinos were 3.45 times more likely to experience depression than whites and 2.22 times more likely than blacks. Stroke survivors with depression were more likely young, Latino, on Medicaid and sicker than non-depressed participants.
"The prevalence of depression in Latino stroke survivors is concerning, and our study is the first to elucidate the true burden of disease in this patient population," said Emma K. Benn, DrPH, Assistant Professor of Health Evidence and Policy at the Icahn School of Medicine at Mount Sinai. "More research is needed to understand why this burden is so much greater in Latinos, and to develop interventions that immediately alleviate symptoms."
- Peer-led Workshop Improves Blood Pressure Control Among Stroke Survivors
The PRAISE trial also evaluated blood pressure control in the 600 patients included in the cohort. Clinicians, educators, and stroke survivors at Mount Sinai developed a six-session, peer-led workshop to educate survivors, identify risk factors, and manage disease. Patients were randomized to the workshop or to a wait list control group. At the beginning of the study, 31 percent of patients had uncontrolled blood pressure. After six months, patients in the workshop reduced their systolic/diastolic blood pressure by 3.6/2.0, compared to the control group, who reduced their blood pressure by only 0.5/-0.5 points. Seventy-six percent of the intervention group demonstrated better blood pressure control compared to 65 percent of the control group.
"Hypertension is a major risk factor for a stroke recurrence, but blood pressure is poorly controlled in stroke survivors," said Carol Horowitz, MD, Associate Professor, Health Evidence and Policy, Medicine at Mount Sinai. "Our data show that, with education, encouragement and support from their peers, stroke survivors will better manage their disease and possibly reduce the likelihood of a second stroke."
- Four-Year Study Confirms Blacks, Especially Black Women, More Likely To Suffer Stroke Than Whites
In the ASPIRE trial (Acute Stroke Program of Interventions addressing Racial and Ethnic disparities) researchers from Mount Sinai, Georgetown University, and the University of Michigan are evaluating racial disparities in stroke incidence in the Washington, DC area. The ASPIRE team is developing a three-pronged approach to stroke prevention, preparedness, and intervention to improve health outcomes in underserved black communities by working with local organizations, local hospitals, and emergency responders to engage the community to identify symptoms and seek help early.
Using a surveillance strategy that included hospital admissions/discharge data and medical chart review, the ASPIRE team evaluated 691 stroke cases between January 2008 and July 2012 to have a firm understanding of stroke incidence in Washington, DC. More than 45 percent of cases occurred in black females. Risk factors including hypertension, diabetes, and smoking were significantly greater in blacks than whites.
The average annual incidence per 100,000 was:
- 171 for blacks compared to 45 for whites
- 65 for black males compared to 19 for white males,
- 106 for black females compared to 26 for white females.
A drug called tissue plasminogen activator (tPA) breaks up the clot causing the stroke and is the only effective treatment. However, the drug must be administered within the first three hours after symptom onset. In a separate abstract, the researchers evaluated the length of time between onset of stroke symptoms in black patients and arrival at the emergency room. They found that patients were 40 percent more likely to arrive in the three-hour window if taken by ambulance, regardless of health insurance. Blacks were 26 percent less likely to arrive early, putting them at increased risk for serious complications or death.
"Our data confirms that significant disparities remain between blacks and whites highlighting the critical need for education and intervention programs to reduce the burden of disease," said ASPIRE principal investigator Bernadette Boden-Albala, MPH, DrPH, Associate Professor and Chief, Divison of Social Epidemiology, Departments of Neurology and Health Evidence and Policy at Mount Sinai. "ASPIRE also demonstrates the importance of engaging the community to raise awareness about stroke symptoms so patients can get to the emergency room early and prevent significant morbidity or mortality."
- Women More Likely to Suffer Second Stroke Than Men
Dr. Boden-Albala is also the principal investigator on the SWIFT trial (Stroke Warning Information and Faster Treatment study) trial, which enrolled 1201 mild and moderate stroke survivors from northern Manhattan in a trial focused on stroke preparedness in multi-ethnic communities from 2005-2010. Secondary analyses evaluated the likelihood of stroke recurrence in women versus men. A total of 31 percent had recurrent events. The female group was older, more likely to have high blood pressure, consisted of fewer whites, was less educated, and had more Medicaid recipients than males. About 35 percent of females and 28 percent of males had a recurrent event. Women were 1.35 times more likely to suffer a recurrent stroke than men.
"Age has long been associated with risk of recurrent stroke, but our research shows that a greater risk for women than men, regardless of age," said Dr. Benn. "We look forward to studying these groups further to clearly understand why women have this increased risk, especially among Whites compared to racial/ethnic minorities, and develop health education tools and programs to reduce that risk."
Findings from the SWIFT Community study of healthy adults presented by program manager Leigh Quarles, MPH, CPH, CHES, suggest that appropriate intervention strategies which include visuals, storytelling, and group interactions can overcome disparities in health literacy to improve stroke preparedness knowledge attainment for all race-ethnic groups.
"In addition to researching new interventions and treatments, Mount Sinai has made a critical commitment to understanding why there are significant differences among Whites, Blacks, and Latinos in recognizing the symptoms of stroke, seeking care urgently, and maintaining post-stroke health to prevent a recurrence," said Stanley Tuhrim, MD, Director of The Mount Sinai Stroke Center and Professor of Neurology and Geriatrics and Palliative Medicine at The Mount Sinai Medical Center. "We are developing clinical programs and educational tools to help address these gaps and help the community we serve to live long, healthy lives."
PRAISE was supported by grant UL1TR000067 from the National Center for Advancing Translational Sciences and grant 5P60MD000270 from the National Institute on Minority Health and Health Disparities, a division of the National Institutes of Health. ASPIRE, SWIFT, and SWIFT Community are supported with funding from the National Institute of Neurological Disorders and Stroke, also a division of the National Institutes of Health.
Stroke is one of the leading causes of death and serious, long-term disability in the United States, according to the American Heart Association/American Stroke Association. On average, someone suffers a stroke every 40 seconds; someone dies of a stroke every four minutes; and 795,000 people suffer a new or recurrent stroke each year.
The Mount Sinai Stroke Center, one of the first multidisciplinary stroke centers of its kind and the first in Manhattan, was established in 1988 to develop new approaches to diagnosing and treating stroke. The Center has pioneered major advances in medical therapies for treating and preventing stroke, neurosurgical techniques for stroke prevention and innovative interventional neuroradiologic procedures for stroke patients, with the goal of significantly improving the chances that a patient can prevent, or recover optimally, from a stroke. The Mount Sinai Stroke Center is actively involved in community outreach activities and in potentially groundbreaking research to optimize chronic disease self-management skills in stroke and Transient Ischemic Attack (TIA) survivors.
About The Mount Sinai Medical Center
The Mount Sinai Medical Center encompasses both The Mount Sinai Hospital and Icahn School of Medicine at Mount Sinai. Established in 1968, the Icahn School of Medicine is one of the leading medical schools in the United States, and is noted for innovation in education, biomedical research, clinical care delivery, and local and global community service. It has more than 3,400 faculty in 32 departments and 14 research institutes, and ranks among the top 20 medical schools both in National Institutes of Health (NIH) funding and by U.S. News & World Report.
The Mount Sinai Hospital, founded in 1852, is a 1,171-bed tertiary- and quaternary-care teaching facility and one of the nation's oldest, largest and most-respected voluntary hospitals. In 2012, U.S. News & World Report ranked The Mount Sinai Hospital 14th on its elite Honor Roll of the nation's top hospitals based on reputation, safety, and other patient-care factors. Mount Sinai is one of 12 integrated academic medical centers whose medical school ranks among the top 20 in NIH funding and by U.S. News & World Report and whose hospital is on the U.S. News & World Report Honor Roll. Nearly 60,000 people were treated at Mount Sinai as inpatients last year, and approximately 560,000 outpatient visits took place.