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EMBARGOED FOR RELEASE UNTIL 9:00 AM, THURSDAY, APRIL 30, 1998
Some Would Rather Die than Suffer a Severe Stroke, Survey Says For some people, suffering a severe stroke would be worse than dying, according to a survey of 1,261 people at high risk for stroke.
Asked what trade-offs they would be willing to accept to avoid a major stroke, 45 percent of survey respondents answered that they would rather die than suffer a stroke paralyzing one side of the body and leaving them unable to care for themselves. The survey results were released during the American Academy of NeurologyÃs 50th Anniversary Annual Meeting April 25-May 2 in Minneapolis, MN.
A stroke is a sudden loss of blood flow to the brain or bleeding inside the head, causing brain cells to stop functioning or die. This form of brain injury can impair a personÃs ability to communicate and think, as well as control movement.
"A major stroke is one of the most feared events many people can imagine," said study author David Matchar, MD, director of the Center for Clinical Health Policy Research at Duke University in Durham, NC. "So any kind of intervention ñ prevention, treatment or rehabilitation ñ may be worth pursuing. Even modest treatments that help a fairly small but significant number of patients may be worthwhile, since major stroke is such an undesirable outcome."
New treatments for certain types of stroke, such as the clot-busting drug tPA, can result in complete recovery for patients who otherwise might have been severely disabled. The drug must be given within three hours after the start of symptoms. The American Academy of Neurology and other organizations are working to raise awareness of the signs and symptoms of stroke and the need to treat stroke as a medical emergency.
Matchar said, "Stroke prevention and treatment methods are effective but carry risk of complication -- such as bleeding while on warfarin to prevent stroke, surgical complications of carotid endarterectomy to clear blood vessels or bleeding after treatment with the clot-busting drug tPA. If doctors know how patients feel about stroke, theyÃll be better able to choose the right therapy for the patient."
The results of the survey can help both policy-makers and doctors and their patients determine the value of stroke prevention and treatment options, Matchar said.
The survey asked respondents to choose between living 10 years after a major stroke or living fewer years in good health. All surveys stated that the stroke would paralyze one side of the body and leave the stroke survivors unable to care for themselves. Half of the surveys also stated that the stroke survivor would have difficulty speaking and understanding.
Respondents were asked how many years they would give up to avoid a stroke. Forty-five percent, the largest group, said they would rather die than suffer a major stroke. The second-largest group chose to give up as much as three or four years of life to avoid living with a stroke. But 15 percent would rather suffer a stroke and live 10 years than give up any of those years to avoid a stroke.
Matchar said people should determine whether they are at high risk for stroke. Those who are should think about what it would mean to them to have a severe stroke and then let their doctors and families know their feelings, he said.
"These are difficult discussions to have," he said. "But itÃs important for people to think through and share their values before decisions are made about interventions and treatments."
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