The way Jonathan Griffin puts it, the first sign of his stroke sounds like a line from a classic Blues tune.
“I woke up stumbling,” said Griffin, 43. “I was stumbling and I was tilting to the right.”
When his family asked him what was wrong, he tried to say he didn’t know but nothing came out.
“I was conscious but I couldn’t get out what I was trying to say,” Griffin said. Fortunately, his family called an ambulance and it occurred to him as they turned on the siren that he might be in trouble.
“That sounds serious,” he thought. “They rushed me down there” to the Comprehensive Stroke Center at AU Medical Center, where he was able to receive an intervention to remove his clot that is not available elsewhere in Augusta.
While Griffin came out pretty well, others are not in Georgia, Florida and in many other states. In its monthly Vital Signs report, the Centers for Disease Control and Prevention reported that stroke deaths are on the rise in the South in recent years after decades of decline, and rates are stagnant in other states. While stroke deaths have declined more than 76 percent since 1968 among adults 35 and older, and 38 percent since 2000, that decline has roughly leveled off or even increased in most states since 2013, according to the report. That includes an overall 4 percent increase in the South, with a 3 percent increase in Georgia and a whopping 10.8 percent increase in Florida.
“This is an important wake-up call,” said Dr. Brenda Fitzgerald, director of the CDC and a former Commissioner of the Georgia Department of Public Health. It is particularly alarming among those ages 35-64, which made up a third of the more than 32,000 “excess stroke deaths,” those who died from stroke who might not have had the death rates continued their decline.
“This is alarming and we are working hard to find out what led to the change,” Fitzgerald said. But what is causing the increase or stagnation is not entirely clear, officials with the CDC said. They point to increasing rates of obesity, diabetes and pre-diabetes, high blood pressure and other chronic conditions.
“For example, more than one-third of adults are now obese and one-third have high blood pressure,” Fitzgerald said. “These are very disturbing trends.”
The rates are also increasing for those who, like Griffin, might not consider themselves at risk.
“Despite popular belief, strokes don’t only impact older people,” said Robert Merritt, chief of epidemiology in the Division of Heart Disease and Stroke Prevention at CDC. “Our data show an increasing number of middle-aged adults having strokes.”
He acknowledged there is a need to better educate this population about their potential risk and to tailor that outreach to them.
“We need to take the messages (to) where these individuals are,” Merritt said. “We need to make these messages resonate with these folks. This particular age group, men in particular, don’t utilize health services like they probably should. We have an opportunity there.”
Explaining why there might not be a decline or a slight increase is “a bit complicated because there are so many factors that go into having a stroke and how patients do,” said Dr. Jeffrey Switzer, director of the AUMC Comprehensive Stroke Center. One way to look at is to look back at where death rates were and “see how far we’ve come in stroke care,” he said. Those efforts may have run into a “ceiling effect” in terms of reducing the death rate, Switzer said.
“We’ve gotten as far as we can go with what we’ve done in the past and now we have to think about new strategies,” he said. One would be to help younger patients understand their risk factors for stroke and the need to get them under control but also to recognize the symptoms and the urgent need to seek treatment. The other would be for providers to recognize those younger stroke patients too, which might not be happening now.
“It is more likely they are not going to get a thorough investigation to consider a stroke or as timely treatment as they may need because people are going to say they are too young to have a stroke,” Switzer said.
The increase or lack of decline in the last couple of years flies in the face of increasing the acute care stroke patients can receive at comprehensive centers like AUMC, such as the thrombectomy that Griffin received. By the time he reached the hospital, he was judged to be well outside the 4.5-hour window for receiving a clot-busting drug but he could still receive the thrombectomy, where a catheter was threaded through an incision in the groin up through his neck to pluck the clot causing the stroke.
“These patients still can be eligible and benefit from acute treatments whereas we couldn’t do this up until the last couple of years,” Switzer said. “The whole way we are recognizing and treating these patients is changing and changing dramatically.” But the treatment in Georgia is only available in Atlanta and at AUMC so getting to the right place mattered for Griffin, he said.
Nearly a month after his stroke, Griffin is still using a cane to compensate for some weakness on his right side and he is taking aspirin and a cholesterol-lowering drug to help with a problem he didn’t even know he had prior to his stroke. Still, he considers himself lucky.
“I made it out alive,” Griffin said.
Reach Tom Corwin at (706) 823-3213