Abstract WMP108: Stroke Prevention by Screening Seniors for the Silent Carotid Artery Disease, Atrial Fibrillation, and Hypertension that are the Immediate Causes of Stroke
Background— Stroke is the leading cause of disability and health care expenditures in the United States. Carotid artery disease, atrial fibrillation, and hypertension; are the immediate primary causes of stroke. These causes are silent in 80% of cases prior to the stroke but can be discovered by screening, and with follow-up full evaluation of and preemptive management of those positive on screening, strokes can be prevented.
Methods— A quick carotid scan (QCS) with ultrasound is used to screen for carotid artery disease and had a sensitivity of 93% in our laboratory and 97% at NYU. A stroke prevention screening protocol was employed and used the QCS for carotid artery disease, an EKG rhythm strip for atrial fibrillation, and blood pressure determination for hypertension. The protocol takes approximately 5 minutes to accomplish at a cost of $35.
Results— Screening over 22,146 seniors in the Society for Vascular Surgery National Screening Program, at Kaweah Delta District Hospital in Central California, at New York University, and at Madigan Army Medical Center found a uniform 7.5% with possible >60% carotid stenosis, 5.1% with unknown atrial fibrillation, and 29.5% with inadequately controlled hypertension. Based on this yield of stroke potential carotid artery disease, it was estimated that screening 40 million Medicare recipients in the United States for carotid artery disease alone would prevent over 200,000 strokes annually and, when the cost of the screening, further evaluation, and management was subtracted from the cost of the strokes prevented, save nearly 13 billion dollars.
Conclusions— Screening seniors for the silent immediate causes of stroke, carotid artery disease, atrial fibrillation, and hypertension, coupled with full evaluation of those positive on screening, and safe and effective management has the potential to prevent strokes on an epidemiological scale and should be adopted.
- © 2012 by American Heart Association, Inc.