Preventing Stroke

Miller School gets $3.7 million grant to launch initiative aimed at reducing stroke disparities.

Coral Gables (May 06, 2013) — A $3.7 million grant from the National Institutes of Health (NIH) will allow the Miller School of Medicine to launch the new Florida Puerto Rico Collaboration to Reduce Stroke Disparities. “Our mission is to improve the treatment and prevention of stroke among Hispanics,” said principal investigator Ralph L. Sacco, professor and chair of neurology and Olemberg Family Chair of Neurological Disorders.

“Initially, we will seek to identify any disparities in acute stroke care and secondary stroke prevention by race, ethnicity, and region,” Sacco said. “Then, we will draw on those findings to educate physicians and other health care professionals about evidence-based approaches to improve the quality of care for stroke patients.”

The five-year Florida Puerto Rico Collaboration to Reduce Stroke Disparities (FL-PR CReSD) is part of a national collaborative initiative sponsored by the NIH’s National Institute of Neurological Disorders and Stroke. Under the guidance of the Miller School, with the active participation of the University of Puerto Rico and the American Heart Association, the FL-PR CReSD will examine both the acute and follow-up care provided to stroke patients in Florida and Puerto Rico.

“African-Americans and Hispanics have a greater risk of hypertension, diabetes, obesity, and metabolic syndrome than non-Hispanic whites,” said Sacco, who is also executive director of the Evelyn F. McKnight Brain Institute. “We need to identify the best approaches to improving stroke care for African-Americans and Hispanics, the nation’s largest and fastest-growing ethnic minority population. That includes prevention programs as well as ensuring that stroke patients receive appropriate post-discharge care, reducing the likelihood of a costly hospital readmission.”

With this high-impact, multidisciplinary research program, the Miller School will collect patient data from nearly 140 hospitals in Florida and seven in Puerto Rico to create a new Florida Puerto Rico Stroke Registry. Data will be drawn from hospitals participating in the American Heart Association’s quality improvement program called “Get With the Guidelines-Stroke,” which is designed to ensure that hospital care is aligned with the latest scientific guidelines. “We are hoping for an 80 percent participation rate, which will allow our research team to review thousands of patient records dating back to 2006,” Sacco said.

To coordinate this new initiative, build ties among collaborating institutions, and support the public health and scientific aims of the registry, the Miller School’s program incorporates three related components:

• An Administrative Core to integrate the principal components of the Florida Puerto Rico Stroke Registry. Edison A. Sabala serves as the administrative director of the FL-PR CReSD and provides financial and administrative oversight of the program.

• A Research/Education Training Core focused on stroke disparities, research, and educational training for health care professionals, including clinicians, nurses, residents and fellows, and pharmacists in Florida and Puerto Rico who care for stroke patients. This core is led by Jose Romano, professor of clinical neurology and chief of the Stroke Division; Erin Kobetz, associate professor of public health sciences and director of the Jay Weiss Institute for Health Equity at Sylvester Comprehensive Cancer Center; and Enid J. Garcia-Rivera, medical epidemiologist at the University of Puerto Rico.

• A Data Management and Biostatistics Core to provide integration of data analysis and collection. This core is led by Sacco and Tatjana Rundek, professor of neurology and chief of the Clinical and Translational Research Division. Two members of the neurology department, Hannah Gardener, epidemiologist, and Chuanhui Dong, research assistant professor and biostatistician, will work with Sacco and Rundek in data analysis and publication of study results.

Other partners in the stroke research program include Mary Robichaux, vice president for Quality and Systems Improvement Programs for the American Heart Association; and consultants Juan Carlos Zevallos, adjunct associate professor in the Department of Human and Molecular Genetics at Florida International University, and Ulises Lisandro Nobo, acting director of the Stroke Center at HIMA-San Pablo Caguas Hospital, Caguas, Puerto Rico.

To guide the project, the Miller School research team will create a project website, establish a program advisory committee, and host an annual stroke stakeholders’ conference. “As a nationwide NIH-funded collaboration, we will be sharing our findings with three other participating centers in California and New York,” Sacco said.

“Given the relative scarcity of data on stroke disparities among Caribbean-origin Hispanics, it is essential to conduct research to help inform future national efforts to address this rapidly growing and important segment of our population.”

An internationally renowned neurologist and epidemiologist, Sacco has published extensively in the areas of stroke prevention, treatment, risk factors, stroke recurrence, and genetics. Sacco has been a leading author on numerous evidence-based guidelines from the American Heart Association, has received the Feinberg Award for Excellence in Clinical Stroke from the AHA, and was the first neurologist to serve as the national president (2010-2011) of the American Heart Association.

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Investigators on the stroke study include, seated from left, Jose Romano, Ralph Sacco, and Tatjana Rundek. Standing, from left, are Edison A. Sabala, Erin Kobetz, and Chuanhui Dong.

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