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COAH Researchers Contribute to Study Finding Racial Disparities in Stroke Medication Management & Underscore Caregivers’ Role in Preventing Another Ischemic Stroke

Stroke is a major cause of morbidity and mortality in the US, and a prior stroke is one of the biggest risk factors for future stroke events. Stroke survivors face a 13% increased risk of a subsequent stroke in the first year after stroke, and over 40% experience a second stoke within 10 years. Prior stroke history is also a major risk factor for other cardiovascular events and mortality. Preventing a second stroke is critically important among initial stroke survivors, and the use of secondary prevention medications can reduce the risk of additional stroke event by more than 80%.

“After a stroke, compliance with prescribed medications dramatically reduce the chance of another cardiovascular event. Having an engaged caregiver improves medication adherence for stroke survivors. We need to do more to understand why Black stroke survivors stop antithrombotic medications more frequently than White stroke survivors and address potential racial disparities in recurrence rates,” said lead researcher Orla C. Sheehan, MD, PhD at the Johns Hopkins Center on Aging and Health (COAH) and team examined health care disparities between Black and White stroke survivors based on data from the Caring for Adults Recovering from the Effects of Stroke (CARES) study, an ancillary study of the national REasons for Geographic and Racial Differences in Stroke (REGARDS). The national REGARDS study was designed to identify the causes of regional and racial disparities in stroke mortality, and CARES data enabled the team to analyze information among 172 stroke survivors paired with 160 caregivers. Johns Hopkins researchers Chelsea Liu, Dr. Jin Huang, and COAH Director Dr. David L. Roth were also on this team.

They found that 10 months after hospital discharge, Black stroke survivors were more than twice as likely as White stroke survivors to have discontinued antithrombotic medications, known to help prevent another ischemic event, despite having similar prescription rates at the time of hospital discharge. Antithrombotic usage decreased by 18% for Blacks compared to only 8% for Whites. These findings suggest that Blacks may be at an increased risk of experiencing a second stroke compared to Whites. Delving deeper into the data, they also observed that Black stroke survivors were less likely than White stroke survivors to live with a family caregiver. Interestingly, researchers found that antihypertensive persistence was high regardless of race; the research team credit that fact to effective public health campaigns, such as the National High Blood Pressure Education Program.

“In our cohort, persistence to secondary preventive medication regimens was high likely due to the presence of an engaged caregiver. Routine involvement of caregivers in medication management at the time of hospital discharge and during follow up has the potential to increase adherence to secondary prevention regimens. Use of both antithrombotic and lipid lowering medications fell over time in our population, likely increasing the subsequent stroke risk in those participants—particularly Black stroke survivors who were significantly more likely to discontinue antithrombotic medications The effect of changes in patterns of medication usage on health outcomes particularly in Blacks deserves continued investigation,” added Sheehan.

Sheehan and her team underscore that vigilant caregiver help with medication management is critically important to increase adherence to secondary stroke prevention medications, thereby decreasing the odds of their loved-one having another stroke event. Also, the research team suggests that public health campaigns focused on groups of medications—not just blood pressure medications—may help educate stroke survivors about how important they are to preventing secondary vascular conditions. Moreover, the team believes that the effect of changes in patterns of medication usage on health outcomes, especially in Blacks, warrants further research.

Drs. Sheehan and Roth are available for interview.

Click here to read the full report in Health & Ethnicity.

Click here to read the study.

 

Sarah-Szanton

Congratulations, Dean Szanton!

We at COAH join the thunderous rounds of applause in celebrating that Dr. Sarah Szanton was named as the new Dean of the Johns Hopkins School of Nursing. She began her term on August 25th to much fanfare. Indeed, “I’m a Sarah Fan” signs were waving at the State of the School speech she delivered on the first day of her term. And there are many reasons to be a fan of Dean Szanton. She co-developed the CAPABLE program, which helps seniors age in the community; CAPABLE received a lot of attention earlier this year under the new White House administration as a model of how communities nation-wide can better respond to the needs of our older adults, and it has now spread to 44 communities in 23 states!

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Throughout her career at the Johns Hopkins School of Nursing and as a Core faculty member of the Center on Aging and Health, Dr. Szanton has been an exemplary mentor, insightful researcher, and a superb gerontologist.  She has a demonstrated commitment to resolving health disparities among minorities, and she treats everyone she encounters with dignity and respect.

We are excited to see Sarah Szanton become Dean of the School of Nursing, and we wish her every success.  Read more about Dean Szanton’s accomplishments throughout her career at the School of Nursing here.

 

 

 

 

 

Cynthia M. Boyd

Dr. Cynthia Boyd Named Director of the Division of Geriatric Medicine and Gerontology!

 

Many congratulations to Dr. Cynthia Boyd, who was named the new Director of the Division of Geriatric Medicine and Gerontology of the Johns Hopkins School of Medicine at the beginning of August.  She previously held the position as Interim Director after Dr. Samuel Durso became the Director of the Department of Medicine at JHBMC in 2020.

In addition to her appointment as Professor of Medicine, Dr. Boyd has joint appointments in Health Policy and Management and in Epidemiology at the Johns Hopkins Bloomberg School of Public Health.  Beyond being core faculty at COAH, she is also faculty with the Roger C. Lipitz Center for Integrated Health Care, as well as the Johns Hopkins Center for Transformative Geriatric Research.  She is a Multi-Principal Investigator with the US Deprescribing Research Network.  And she co-directs a T32 grant on Health Services Research Outcomes for Aging Populations.  Additionally, Dr. Boyd is a Center for Innovative Medicine Scholar.  Earlier this year, she was inducted into the American Society for Clinical Investigation.

A former Beeson Scholar and Robert Wood Johnson Physician Faculty Scholar, Dr. Boyd earned her MD from Duke University and her MPH from the University of North Carolina at Chapel Hill.  She completed her residency at Johns Hopkins and performed a fellowship in geriatric medicine and gerontology at Johns Hopkins.

Known for her affable nature, keen research insights, strong commitment to mentorship, and international expertise in the care of persons living with multiple chronic conditions, we at COAH are confident in her leadership, and wish her all the best in her new leadership role.