The Importance of Follow-up Care after Stroke
Dr. Curiale explains the importance of follow up care after a stroke, recovery treatment options and BMC's recognition from the American Stroke Association for the involvement in Get With The Guidelines® program which helps patients receive the benefits of the latest guidelines-based treatment.
Gioacchino (Jack) G. Curiale, MD is the Chief and Medical Director of Stroke Services at Boston Medical Center. Dr. Curiale obtained his bachelors degree in Biology from Harvard University and attended medical school at the University of Massachusetts Medical School. He completed additional training as an intern in Internal Medicine at Yale-New Haven Hospital and then became a resident in Neurology there as well. Dr. Curiale is board-certified in neurology and vascular neurology.
Melanie Cole (Host): Welcome. Today, we’re talking about the importance of follow up care after stroke. My guest is Dr. Gioacchino Curiale. He’s the Chief and Medical Director of Stroke Services at Boston Medical Center. Dr. Curiale, what a great topic. People think of stroke, they think of symptoms and maybe what happens in the emergency room but tell us why it’s so important that patients follow up with a stroke specialist, a neurologist after they’ve suffered their stroke.
Gioacchino (Jack) Curiale MD (Guest): Hello and thank you for having me on your show. Stroke is one of the leading causes of disability and mortality in the United States and across the world. And when many of us think about stroke we’ve heard the message about FAST, face, arms, speech, time and the importance of getting to the emergency room immediately to get care for your stroke. However, stroke care although it takes place early on, also takes place after hospitalization as well.
Although many patients may be able to go home after a stroke, many other patients will have to go to rehab or will have rehab services at home and will need to follow up with a stroke neurologist and their primary care doctor after discharge. The stroke workup begins in the hospital to find out what the cause of the stroke was and initiate treatment. However, oftentimes that workup has to continue after discharge and it’s a process of getting to the answer of what may have caused the stroke. So, following up with a neurologist is very important because that neurologist can help to find the cause of the stroke and really tailor the treatments to that cause to do the best job possible to reduce the risk of another stroke happening.
Although there are many good treatments for stroke, about 80% of strokes are still avoidable. Those are recurrent strokes. They are still avoidable if risk factors can be appropriately and adequately modified. So, stroke risk factors include high blood pressure, high cholesterol, smoking, diabetes, and risk factors such as these which are potentially modifiable and treatable. So, that’s why follow up after a stroke is really important and working closely not just with the neurologist but also primary care doctor to really work on treating those risk factors.
Host: So, what are some of the challenges a stroke patient may be facing? Tell us about depending on the level of disability suffered, what are some of their challenges?
Dr. Curiale: Sure, well challenges can include any number of things. One is returning to home and work. Another is mobility, being able to get to appointments to see the doctors also is potentially a challenge. Some patients who go through rehab will need to make arrangements for follow up in coordination with their rehab as well as with potentially their caregivers to get to the appointments.
So, there are a number of different challenges they face. I think the key challenge that patients face who have had a severe stroke is really that transition to maybe needing help and getting those services in place. So, potential services would include getting for instance home physical therapy or occupational therapy, help at home, modifying the home potentially to accommodate any disability so that the patient will be able to function at home potentially with assistance. Some patients’ speech might be affected for instance and they may have to work with a speech therapist to be able to improve their communication.
So, these are all just various barriers to getting back to home life, getting back into the community and being able to achieve a level of functioning.
Host: So, when does stroke rehab start Doctor? What do the treatments look like? You mentioned speech therapy. Tell us a little bit about some of the treatments that might be offered and where does it mainly take place?
Dr. Curiale: Sure, so patients who come into the hospital with stroke symptoms are screened for rehabilitation needs. So, in the hospital, we have various therapists including speech therapists, we have physical therapists and occupational therapists. They all work on different aspects of function and determining what the specific needs are. So, in the hospital, when they assess patients, the therapists will be able to help determine what level of rehabilitation a patient may need so for instance some patients may be able to return home with no therapy if their stroke symptoms have resolved. Other patients may need outpatient therapy needs. Other patients may need to go to an acute rehab where therapy happens in an intensive setting.
So, the rehabilitation really starts as soon as we start assessing them in the hospital for their needs and the therapists will work with patients and their families to figure out what the situation is at home, if the patient would need services and then we put in referrals to the appropriate rehabilitation setting and work with those organizations to set the patients up with the appropriate level of follow up therapy care. So, really the rehabilitation phase, although we initiate it in the hospital in terms of assessment and getting things started; really happens once the patient leaves the hospital where the rehabilitation phase really accelerates.
So, if a patient goes to acute rehab for instance, they are really going to be working intensively with a therapist, with various therapists potentially to get better and regain function.
Host: Then tell us, because I think a lot of people wonder, can the brain heal itself after a stroke Doctor and tell us what types of providers are involved in this rehabilitation. You mentioned a few of them, but there are some others. There can be many actually and what recovery is really possible.
Dr. Curiale: Sure so, every patient is different and the capability for recovery is different with every patient as well. Recovery can take place over several months after a stroke. And so, it’s important to be patient but it’s also important to really start that rehabilitation phase as soon as possible to get as much benefit as possible early on.
In terms of different providers who take place in the therapy, it’s not just neurologists, however, that’s part of the team. It’s also speech therapy, physical therapy, occupational therapy. There are physiatrists who are physicians who specialize in rehabilitation care as well. And so this is really sort of the spectrum of care that takes place. Depending on the level of rehabilitation services, so for instance like acute rehabilitation, there are other care providers involved as well. And then sort of at home physical therapy regimen or outpatient physical therapy regimen is really targeted to specific domains of recovery and working closely with the outpatient therapists to really hone in on the specific needs of the patient.
I think the key thing to take home is that recovery takes time and can happen over the course of many, many months and patients can see improvement many months out from their initial stroke.
Host: Then tell us a little bit about BMC’s recent recognition by the American Heart Association and the American Stroke Association for active involvement in Get With the Guidelines Program. Tell us what that is, what it means and how it benefits the community.
Dr. Curiale: Sure so, Boston Medical Center participates in a number of stroke quality improvement programs including Get With the Guidelines which is a national stroke quality improvement registry. We also participate with the state’s BPH’s Coverdale Program which is a national program run through the Centers for Disease Control and Prevention. And Boston Medical Center has consistently achieved highly in the Get With the Guidelines Program and in 2019, we received the highest level of award for the quality of care we provide.
We also achieved the Target Stroke highest level of award. Target Stroke is a national program which encourages treatment with IV alteplase which is an acute treatment for stroke and the goal of increasing utilization and early treatment at Boston Medical Center was able to achieve the highest level on that measure as well.
So, why is this important for the community? That’s because I think it demonstrates that we provide a high level of service, high quality of service as a comprehensive stroke center and that this helps us to rapidly treat our patients and we know that the sooner a patient is treated for their stroke; the more likely they are to have a good outcome. I should also add that the Boston Medical Center Comprehensive Stroke Center does aim to interact with the community and to improve stroke awareness and to encourage patients to recognize stroke symptoms and be able to act on those symptoms and get to help as soon as possible.
Host: What great information and a great program. As we wrap up, Dr. Curiale, tell us some of the steps you’d like the family members of someone who suffered a stroke to know about helping stroke patients work towards that independence, a little bit of life after stroke and what you’ve seen in your every day practice.
Dr. Curiale: Sure so, I think that again, what’s important to remember is that stroke rehabilitation takes time and patients can make improvements many months out. So, I think it’s important to have that sense of hope when facing the situation which is a life changing situation of a new stroke. What’s important for family members to know is that their loved ones can have potential to improve and that their support is important. Being able to help patients get to their appointments to see their doctors, to also help in recognizing any new stroke symptoms because we do know that one of the risk factors for having another stroke is a past history of a stroke.
So, being able to recognize a stroke and know what to do which is to call 9-1-1 and get the patient to the hospital as soon as possible is very important.
Host: It’s really great information Doctor, thank you so much. As someone who is going through this right now, listeners, I can tell you that everything he said is such great information and important for family members to hear. Thank you again.
And that wraps up this episode of Boston MedTalks with Boston Medical Center. Head on over to our website at www.bmc.org/stroke for more information and to get connected with one of our providers. If you found this podcast as informative as I did, please make sure you share with family members and friends and on your social media and be sure to check out all the other interesting podcasts in our library. I’m Melanie Cole.