Transcript : Vital Signs Preventing Stroke Deaths

Press Briefing Transcript

Wednesday, September 6, 2017

• Audio Recording [MP3 – 4 MB]

MICHELLE BONDS: Thank you operator. And thank you all for joining us today for the release of a new CDC Vital Signs. We are joined by CDC Director Dr. Brenda Fitzgerald, as well as Robert Merritt, Chief of the Epidemiology and Surveillance Branch in CDC’s Division for Heart Disease and Stroke Prevention, and the lead author of the science article, Dr. Quanhe Yang, (pronounced Sh’won-her Yang), also with the Division for Heart Disease and Stroke Prevention. Dr. Fitzgerald is unable to remain with us for the entire telebriefing, but following their brief remarks, Dr. Anne Schuchat, Dr. Merritt and Dr. Yang will take your questions. Thank you. Dr. Fitzgerald?

BRENDA FITZGERALD: Good afternoon and thank you for joining us today. CDC provides for the common defense of the country against health threats. Each month in our Vital Signs report, we focus on a disease from the frontlines and give you information to help stop it. Today’s report contains new information about stroke, a leading cause of death nationwide. What our report reveals is a slowdown in progress after decades of decreasing stroke death. We’re also seeing more strokes happen in certain populations including Hispanics, Blacks and people living in the south. This is an important wake up call. The majority of strokes we see are avoidable and we know how to prevent them. Every 40 seconds in the United States, someone has a stroke and more than 140,000 people die from it each year. It also costs the nation $34 billion annually. Some of you may have experienced a stroke firsthand or loss of loved one. I myself lost a friend and colleague, Senator Paul Coverdell, who died unexpectedly in 2000 after the early age of 61 from a massive stroke. His legacy now continues through the CDC’s Paul Coverdale National Acute Stroke Program, which you will hear more about later in this call. We at CDC know that health providers are on the front line of stroke prevention efforts and we’re committed to giving doctors, patients and state and local health departments the information they need to help improve outcomes. I realize this is a big undertaking and I say this from experience as the health commissioner in Georgia, a state in the heart of the stroke belt though we have improved health for stroke patients in the hospital and before and after they get there. More than 60 hospitals now participate in the Georgia Coverdell Acute Stroke Registry Program. From primary stroke centers to local hospitals and health departments serving rural areas all working together to help improve the stroke system of care. In Georgia, we saw good results early in these efforts with evidence of fewer stroke deaths in participating hospitals between 2008 and 2013, especially among the hospitals providing the highest level of care. Unfortunately, this Vital Signs shows a recent reversal in some of Georgia’s progress. And across the nation it stalled in three out of four states. This is alarming and we’re working hard to find out what lead to the change. We know that the rising rate diabetes, prediabetes and high cholesterol and other chronic conditions are taking a toll. For example, more than one third of the adults are now obese and one third have high blood pressure. These are very disturbing trends. This new information shows that more middle aged adults, those ages 35 to 64 are having strokes and we’re seeing more of them with these chronic risk factors that contribute to stroke, like high blood pressure, lipid disorders, diabetes and obesity. So it’s clear that we have work to do to reduce this burden. There’s no one answer. It will take all of us. Public health, health systems, doctors, nurses and health care professionals to work together to make sure that short-term trend of a decrease does not become a long-term one. We made great progress in reducing stroke deaths over the past few decades, but this report shows it’s time to increase our efforts. We cannot afford to be complacent when so many deaths could be prevented. I will now ask Mr. Merritt, the epidemiologist to share more details from today’s report. Thank you very much.

ROBERT MERRITT: Thank you Dr. Fitzgerald. I’m joined by the lead author of this study, Dr. Quanhe Yang, who will be on hand for the question and answer portion of this briefing. For this Vital Signs report, we analyzed stroke death between 2000 and 2015 to determine the changes in trends in stroke death rates. From 2000 and 2013, stroke deaths decrease by an estimated 4% each year. Stroke death rates decline 38% from 118.4 per 1,000 people in 2,000 to 73.3 per 100,000 in 2015. In 2013, the decline in stroke death rates began to stall. And from 2013 through 2015, the decline in stroke death rates stalled in 38 states. A reversal in stroke death rates was seen among certain sub-populations in geographic areas. The south, which includes the stroke belt saw a 4% increase in the stroke death rate each year from 2013 to 2015. However, we found increases in many states outside of the south. There’s disparities among demographic groups. For example, Hispanics experienced a 6% increase in their stroke death rate each year from 2013 to 2015. African Americans, who traditionally are the hardest hit by stroke, continued to have the highest death rate compared to other race and ethnic groups. And despite popular belief strokes don’t only impact older people. Our data show an increasing number of middle aged adults are having strokes, which can cause lifelong disability. Although these findings are concerning, there are many things can be done to reverse this trend. For example, health systems can use system wide approaches to find patients with undiagnosed or unmanaged stroke risk factors. They can also work with emergency medical systems to quickly identify strokes and get patients to the hospital quickly. These health systems can also implement a coordinated system of care that efficiently treats patients from the first symptom of a stroke through recovery. Doctors, nurses and other health care professionals also play a vital role. They can help patients control their blood pressure by taking medicines as directed and making lifestyle changes that help prevent stroke. This includes helping patients manage stroke risks , and referring them to community resources such as smoking quit lines, and obesity and diabetes prevention programs. They can also educate patients on the signs and symptoms of stroke and the importance of calling 911 right away if someone is having a stroke. People can prevent strokes and prevention at any age begins with managing important risk factors. This includes a maintaining a healthy blood pressure, managing cholesterol and diabetes and stopping smoking. Also, following a healthy diet and exercising regularly. We also must know the signs and symptoms of stroke to help ourselves and others. One strategy is to act fast, as in F-A-S-T. “F” stands for facial drooping, “A” for arm weakness, “S” for speech difficulties, and “T” stands for time which means it’s time to call 9-1-1 since a stroke is a health emergency. Reducing stroke deaths is a priority for the Federal government. Two national efforts focused on this include the Paul Coverdell National Acute Stroke Program, which Dr. Fitzgerald referenced earlier, and the Million Hearts Initiative. The Million Hearts Initiative aims to prevent 1 million heart attacks and strokes by 2022 by keeping people healthy, optimizing clinical care and focusing efforts on priority populations. The Coverdell program partners with state health departments, emergency medical systems and hospitals to use data driven quality improvement strategies to deliver high quality stroke care. State health departments, for example, can use data to identify gaps and improve quality of stroke care. They can also train emergency medical staff to identify the signs of stroke and understand the importance of getting patients to the hospital quickly. CDC continues to research stroke treatment recovery and prevention. We also support the National Institute of Health’s Mind Your Risks public education campaign to increase awareness of the importance of brain health and the connection between high blood pressure and dementia. By linking the efforts of health systems, state and local health departments, individuals and the coordinated efforts of the Federal government, we can resume our progress in reducing stroke deaths. With an estimated 800,000 strokes occurring each year – and 1 in 20 adult deaths due to stroke – we must work together to protect American health. Thank you very much and I turn it back to our moderator.

MICHELLE BONDS: Thank you. Operator we are ready for questions.

OPERATOR: As a reminder if you’d like to ask a question at this time please press star, then one and state your name when prompted. If you’d like to with draw your question please press star 2. The first question comes from Mike Stobbe of Associated Press. Your line is open.

MIKE STOBBE: Hi, thank you for taking my question. I had a couple questions. Regarding stroke, what happened in 2013? Why was 2013 the turning point do you think? Also, the Paul Coverdell program has been in place for a while, but we saw this increase in the south. Did it not work or can you speak to what that did and didn’t accomplish and why we saw this recent trend? Lastly, could you address the hurricane? What is the condition of the CDC campus in Puerto Rico? Are personnel okay? What are the plans and issues that CDC and HHS are planning for? What are you planning for in the days ahead? Thank you.

MICHELLE BONDS: Okay I’m going to ask Mr. Merritt to start us off with the first question and Dr. Yang will follow.

ROBERT MERRITT: Thank you for your question. Well, I think clearly you noted that something happened in 2013. We were observing a very steady decline in stroke death rates. From 2,000 to 2013 and saw a slowing and then a reversal in some of the sub-populations. My explanation for that, which we mentioned in our opening comments, which is the continued struggle in this country with risk factors. You know, with increasing rates of hypertension, high cholesterol, obesity, diabetes, physical inactivity. If we can control those I think that will continue to work in favor for a continued decline. However, there are the two other system related issues that I think are of concern. That is the difficulty people have of recognizing the signs and symptoms of having a stroke or their reluctance to seek care, so I think we have an opportunity to educate the public and our providers with that particular protocol. That’s the likely explanation for what we’re seeing and if you look at the sub populations, particularly the younger adults that Dr. Fitzgerald mentioned. We’re watching that group in particular because they have concerning rates of all those risk factors. Dr. Yang, would you like to add something to that?

QUANHE YANG: We see this stroke death rates increase significantly among the southern census states. These southern census states contain 8 of 11, what we call stroke failed states. Those states usually have the highest stroke death rate overall, but this time we see it in the southern states, where it’s much lighter than only the 8 stroke failed states. Many factors may contribute into this change. Why we see the significant increase in those states? In the southern states, we have higher than average stroke risk factors. We have lower than average socioeconomic status. We also see a higher prevalence of poor diets and we’re seeing coming together probably explains why the southern states death rates have increased. That’s why this is a wake up call. Please remember, 80% of strokes are preventable. Everybody can help to prevent the stroke death and prevent the strokes from happening. What we do is two simple things: One, adopt a healthy lifestyle. Control your risk factors like not smoking, eating healthy, and maintain your health rates. If you have conditions, keep them under control. Things like high blood pressure, diabetes, or obesity. Take your medication and keep them under control. This procedure, simple procedure will prevent more people from getting strokes. The very important news is everyone can help to recognize the signs of the stroke. It’s a simple one. F-A-S-T. Face, arms, speak and time. Stroke is a real medical emergency. See the signs, call 9-1-1, and get people to the hospital. We will save lives.

ROBERT MERRITT: So I want to address your second question, which was in regard to the Paul Coverdell National Acute Stroke Program. Yes, you’re right the program has been around for a long time, but you must keep in mind that we have not funded all 50 states with this program. We have been very fortunate to have resources to fund selected states over the years, an evolution of this program. We have seen great improvements in the system of care approach, which basically takes us from the pre-hospital to the hospital and the post-hospital setting. The program evolved overtime from just focusing in on hospital improvements to really engaging EMS, to engaging rehab, to engaging your primary care physician after your discharged. It’s a very different way of approaching stroke here. So I think the systemic changes are being made. We’ve seen the advances in TPA, the clot busting drugs. All those things are very good. But again, if the risk factors remain high and people don’t call 9-1-1 when they have a stroke, it’s going to offset all those good things going on. We’re very proud of the Coverdell program and have very promising results from all of our states.

ANNE SCHUCHAT: Hi, this Anne Schuchat replying on the hurricane front. Of course, CDC is part of the U.S. government response both to hurricane Harvey and preparedness and response to hurricane Irma. As you mentioned, we have installation in Puerto Rico. That’s really been the epicenter of our Zika response. We’re in close contact with staff there and people are fine. We’re, of course, wanting to make sure that we can be part of the response whereever it is needed. The commission core, including staff from CDC, have been a part of the response to Harvey and are on standby for other assistance. If additional details are needed, our press office can help. Just because we are talking about stroke today, I do want to remind people in terms of preparedness, make sure you have your medications with you. Continuity of care for things like high blood pressure can help keep you healthy during response to a hurricane or if you have to suddenly relocate. A number of CDC staff have been assisting family members and making sure that they can get to safe places. Controlling your blood pressure on good days and bad days is important.

MICHELLE BONDS: Thank you Dr. Schuchat. Next question please.

OPERATOR: As a reminder, if you would like to ask a question please press star and 1. The next question comes from Tom Corwin with the Augusta Chronicle. Your line is open.

TOM CORWIN: Thanks for taking my call. I just spoke to a young stroke survivor this morning who would be a classic example of what you’re talking about. He is 43. Had the classic symptoms. Woke up and weakness on the right side and couldn’t speak. His family knew enough to call an ambulance, but he didn’t realize it was serious until the ambulance hit the sirens and he thought well this is serious. Had no idea he was having a stroke. He’s in that 35 to 64 age group where you’re seeing the excess deaths and still didn’t know he was at risk. He’s very fit, but he had high cholesterol. He didn’t know he was at risk. Is there a need to change the messaging, so that this population is getting the message that they’re at risk?

ROBERT MERRITT: I think it gives us an opportunity to do a lot of things in this age group. I think it’s unfortunate that even though this individual was partaking in behaviors that one would think would lead to not having a stroke. I think there are other issues too and that is, you know, family history plays into this a little bit too and we do encourage people to understand the family history of heart disease and stroke because it is relevant to how you approach the entire, you know, your entire lifestyle approach to health. So yes, I would agree that maybe the message is we need to take the messages where these individual are. We need to make them resonate with these folks. This particular age group, men in particular don’t utilize health services like they probably should. We have an opportunity there and we also have an opportunity to just reiterate the two main components of this which again are the controlling the risk factors as well as, you know, using this as an example to educate people on why it’s important to call 911 and how time critical and time sensitive this is. So yes, we welcome the opportunity and we’ll take advantage of the opportunity through both our programs to address this age group.

MICHELLE BONDS: Next question.

OPERATOR: If you’d like to ask question please press star and then 1. Currently there are no questions in queue.

MICHELLE BONDS: Thank you Dr. Fitzgerald, Merritt and Yang for joining us today, as well as, the reporters. For follow-up questions, call the press office at 404-639-3286 or send an email to media@cdc.gov. Thank you for joining us; this concludes our call.