Adam de Havenon1, Shyam Prabhakaran2, Tanya Turan3, Rebecca Gottesman4, Sharon Yeatts3, Natalia Rost5. 1. University of Utah, Department of Neurology, Salt Lake City, Utah. Electronic address: adam.dehavenon@hsc.utah.edu. 2. Department of Neurology, Feinberg School of Medicine, Chicago, Illinois. 3. Department of Neurology, Medical University of South Carolina, Charleston, South Carolina. 4. Department of Neurology, Johns Hopkins University, Baltimore, Maryland. 5. Department of Neurology, Harvard Medical School, Boston, Massachusetts.
Abstract
BACKGROUND: White matter hyperintensity (WMH) is a common manifestation of chronic ischemic microvascular disease that heralds greater risk of functional disability, stroke, and dementia. SPRINT MIND recently reported that intensive blood pressure reduction resulted in lower rates of mild cognitive impairment and WMH progression, suggesting that medical interventions could have a measurable impact on WMH. We conducted an anonymous survey of providers in the NINDS StrokeNet to better understand neurologist attitudes about asymptomatic WMH. METHODS: We sent a 7-question survey to the 29 Regional Coordinating Centers of the StrokeNet, whose coordinators disseminated the survey to providers "involved in the care of a patient after their stroke." RESULTS: We received 136 responses. For stroke prevention therapies, including aspirin and statin therapy and blood pressure target, there was substantial equipoise, with no single option receiving >50% endorsement and between 15-32% of respondents choosing the option of "not sure." 83% of respondents indicated high or moderate enthusiasm for a trial targeting this patient population. The clinical outcomes of reduction in ischemic stroke, cognitive impairment, or dementia were high importance (>70% endorsement), while the remaining radiographic, safety, and clinical endpoints all failed to reach 50% endorsement. CONCLUSIONS: Our survey establishes meaningful neurologist attitudes that can inform future WMH research. There is considerable equipoise regarding optimal medical treatment for patients with asymptomatic WMH and providers in StrokeNet, who would be a vital stakeholder in WMH research in the United States, enthusiastically support a clinical trial to resolve open questions on optimal medical management.
BACKGROUND:White matter hyperintensity (WMH) is a common manifestation of chronic ischemic microvascular disease that heralds greater risk of functional disability, stroke, and dementia. SPRINT MIND recently reported that intensive blood pressure reduction resulted in lower rates of mild cognitive impairment and WMH progression, suggesting that medical interventions could have a measurable impact on WMH. We conducted an anonymous survey of providers in the NINDS StrokeNet to better understand neurologist attitudes about asymptomatic WMH. METHODS: We sent a 7-question survey to the 29 Regional Coordinating Centers of the StrokeNet, whose coordinators disseminated the survey to providers "involved in the care of a patient after their stroke." RESULTS: We received 136 responses. For stroke prevention therapies, including aspirin and statin therapy and blood pressure target, there was substantial equipoise, with no single option receiving >50% endorsement and between 15-32% of respondents choosing the option of "not sure." 83% of respondents indicated high or moderate enthusiasm for a trial targeting this patient population. The clinical outcomes of reduction in ischemic stroke, cognitive impairment, or dementia were high importance (>70% endorsement), while the remaining radiographic, safety, and clinical endpoints all failed to reach 50% endorsement. CONCLUSIONS: Our survey establishes meaningful neurologist attitudes that can inform future WMH research. There is considerable equipoise regarding optimal medical treatment for patients with asymptomatic WMH and providers in StrokeNet, who would be a vital stakeholder in WMH research in the United States, enthusiastically support a clinical trial to resolve open questions on optimal medical management.
Authors: R N Bryan; J Cai; G Burke; R G Hutchinson; D Liao; J F Toole; A P Dagher; L Cooper Journal: AJNR Am J Neuroradiol Date: 1999-08 Impact factor: 3.825
Authors: Mariëlle M F Poels; M Arfan Ikram; Aad van der Lugt; Albert Hofman; Gabriel P Krestin; Monique M B Breteler; Meike W Vernooij Journal: Stroke Date: 2011-02-09 Impact factor: 7.914