Health Care

Strokes and race

WASHINGTON -- Most blacks call a friend or relative instead of 911 when they have symptoms of a stroke, potentially delaying arrival at a hospital and access to life-saving treatment, according to a new study.

The findings, published online last week in the journal Stroke, offer a clue for researchers seeking to understand the disparities in stroke treatment between blacks and whites. The findings have particular significance for predominantly black urban populations, researchers said. The study, by researchers at Georgetown University Medical Center, included interviews with stroke patients at Washington Hospital Center, the largest hospital in the national capital region.

A stroke occurs when a blood vessel in or leading to the brain bursts or is blocked by a blood clot. When this happens, part of the brain can't get the blood or oxygen it needs. Depending on the severity of the stroke, immobility or paralysis might occur.

In the United States, the rate of first strokes in blacks is almost double that of whites, researchers say, because of higher incidences of risk factors such as high blood pressure and obesity. And strokes tend to occur earlier in life for blacks. Yet studies have shown that fewer blacks than whites receive a treatment that breaks up the blood clot in the brain causing the stroke, in part because blacks are not getting to the hospital in time.

"Every minute, more brain cells die. The treatments we have to give are more effective the sooner you give them," said Chelsea Kidwell, director of Georgetown University's Stroke Center, which conducted the research. Even though the window for treatment can be up to 4.5 hours for some people, "the time between hitting the emergency room door and getting the medication should be under 60 minutes," Kidwell said.

But before the medication can be given, lab tests and brain scans need to be performed to determine whether the patient's stroke is of a blockage type, like a clogged pipe, or like a burst pipe, where a blood vessel has burst. The medication known as tPA, or tissue plasminogen activator, works like Drano but is only effective on the blockage type of strokes, Kidwell said. The treatment can significantly reduce the effects of a stroke and reduce permanent disability.

She said the findings have already helped officials tailor educational materials for community sessions researchers are holding in churches and health fairs across the district. They include emphasis on calling 911 immediately and addressing not just potential stroke victims, but also children, siblings and friends, she said.

Researchers from Georgetown's Stroke Center interviewed 230 blacks in the neighborhoods around Washington Hospital Center between 2007 and 2008 and found nearly 90 percent said they would call 911 first if faced with a hypothetical stroke. But when researchers interviewed acute stroke patients at the hospital within 48 hours of admission, they found "an interesting disconnect," Kidwell said.

Seventy-five percent said they called someone else first instead of 911 when they realized something was wrong, 89 percent reported significant delay in seeking medical attention, and almost half said the reason for delay was thinking the symptoms were not serious or they would resolve on their own, Kidwell said.

Of those who did call 911 for an ambulance, 25 percent said they did so because they thought it would be faster, while 35 percent said they had no other transportation option, the study found.