Tackling Stroke in the Nation’s Capital

Posted in GUMC Stories

On a fine day in 2007, Donnie Sisco decided to come home early from his job as a property caretaker on the Eastern Shore. He needed some r-and-r — the headache that hit him the hour before was growing increasingly severe. When he got out of his truck at his house, his left leg couldn’t catch up to his right.

He suddenly felt what he now knows was a blood vessel bursting in the back of his head. The headache was — suddenly, mercifully — gone. But the vision in his left eye became blurry.

He told his wife he was sick and asked her to drive him to the hospital. Donnie had no idea he had just suffered a stroke.
Five years later, Donnie, now 60, can cite all the symptoms of stroke, and he knows it disproportionally affects blacks like him. He carries blood pressure medicine and a blood pressure cuff in his truck. And he won’t touch salt. “I love myself,” he says simply. “I won’t eat what is bad for me.”

He also confesses to feeling affection for “the folks at Georgetown” who visited him in his hospital bed to chat about ways to prevent a second stroke — and then continued to follow his progress closely through the years when he couldn’t work, up to the present day, when he is healthy and back on the job.

“Georgetown saved my life,” says Donnie. “I am grateful to them. I feel the more you know about stroke, the better.”

Sweeter words have never been spoken, says Chelsea Kidwell, M.D., director of the Stroke Center at Georgetown University Medical Center. Since coming to GUMC in 2005, Kidwell has been focusing on understanding the reasons behind disparities in stroke and stroke outcomes among different races and ethnicities in the District of Columbia and surrounding areas.

She says Donnie’s embrace of education on stroke achieves one of the goals that she and her group have been trying to attain in the black community.

Tackling Stroke From Multiple Angles

Stroke is the third leading cause of death in the U.S., and the leading cause of disability. As bad as that is, minority populations are at a higher risk for experiencing stroke and suffering a worse outcome — especially in D.C. But no one knows why that is and Kidwell is dedicated to unpacking the reasons for the incidence and severity, as well as the ways to prevent stroke and treat it more effectively when it occurs.

“As a stroke physician and clinical researcher working in the nation’s capital, where there are significant health disparities, it was a natural drive for me to pursue this work,” says Kidwell, who is a professor of neurology.

Soon after arriving at Georgetown from UCLA, Kidwell secured a five year grant worth over 10 million dollars from the National Institutes of Health called the Stroke Disparities Program. The grant supported her mission to identify the biological and socioeconomic factors contributing to ethnic disparities in stroke, and to develop innovative approaches to reduce those disparities.
Within the program were three separate projects. The Aspire Project sought to understand why blacks are less likely than whites to receive therapies that treat acute ischemic strokes, which are strokes caused by a blot clot.

The Protect DC Project is an intervention designed to test whether in-hospital intervention, coupled with post-hospital stroke education, can prevent occurrence of recurrent strokes.

The DECIPHER Project investigates differences seen in people of different ethnicities and races who have had a stroke— the kind of stroke caused by excessive bleeding due to rupture of a blood vessel. This is the research project Donnie Sisco participated in. Researchers were looking at blood pressure changes because having high blood pressure is a significant risk factor for having a second stroke.

Kidwell has learned a lot from these projects, and has published numerous studies. More are on the way.
A sampling of research that has been published in the last two years includes:

• May, 2011: Although 89% of community members in a predominantly black community in D.C. said they would call 911 first if suffering a stroke, only 12% of patients with stroke interviewed actually called 911 first. Instead, 75% called a relative or friend. Eighty-nine percent of patients with stroke reported significant delay in seeking medical attention.
• August, 2011: Blacks with ischemic stroke were 1/3rd less likely than whites to receive the drug of choice to reverse that kind of stroke. However, blacks were less likely than whites to go to the hospital within three hours of onset, when use of that drug is most effective.
• August, 2012: Blacks who survived a stroke caused by bleeding in the brain had higher blood pressure than whites a year later, explaining why blacks are at greater risk of suffering a second stroke than whites.

Donnie, who took charge of his health, definitely beat the odds as laid out in the last study, says Kidwell.

Center of Excellence for Health Disparities in Our Nation’s Capital

Based in part on the vision, and the success, of Kidwell’s Stroke Disparities Program, The National Institute on Minority Health and Health Disparities, a part of the NIH, awarded a $6.1 million five-year grant in June to establish the Center of Excellence for Health Disparities in Our Nation’s Capital (CEHD). The goal of CEHD is to eliminate or dramatically reduce health disparities with a particular focus on minority populations in D.C. The Center first will address health disparities in stroke and breast cancer.

“The Center of Excellence requires a fully dedicated and engaged University community to achieve meaningful gains toward reducing health disparities,” says Howard J. Federoff, M.D., Ph.D., executive vice president for health sciences and executive dean of the School of Medicine at GUMC. “One of the first goals is to build new, and strengthen existing, relationships between the scientific and lay communities so that we can expedite evidence-based ways of impacting health disparities — particularly those affecting African Americans in the District.”

The Center’s two other co-principal investigators are Lucile Adams-Campbell, Ph.D., associate dean for community health and outreach for GUMC, and Phyllis Magrab, Ph.D., director of the Georgetown University Center for Child and Human Development. Adams-Campbell will lead the research involving breast cancer while Magrab’s task is to lead efforts within the overall P60 network to establish highly effective collaborations, such as that with Howard University.

As part of the new Center grant focusing on stroke, Kidwell proposes to test the use of technology to increase stroke awareness. She plans a pilot program that would place a computer-like device in the home of patients who have had a stroke. The device would remind patients to take their medications, measure their blood pressures on a daily basis, and could provide information about preventing stroke, among other informative modules.

“We hear a lot about barriers to better care, and one of those barriers is a lack of communication between the medical community and the real world,” says Kidwell. “For example, we know blacks are at a higher risk of having strokes and have worse outcomes.

“While the reasons for both issues vary, we know how to reduce the risk and we have some understanding about how to ensure better outcomes,” she says. “Our challenge is take this information across the bridge and into the community where it can have a major impact.”

Kidwell’s program has changed the life of Donnie Sisco. To him, “that is a major impact — to be sure.”

This is part one in a series of stories about the research funded by the National Institute on Minority Health and Health Disparities P60 grant awarded to establish the “Center of Excellence for Health Disparities in Our Nation’s Capital.”
(Grant #1P60MD006920-01)

By Renee Twombly, GUMC Communications