Three inexpensive tests could help detect risk of stroke.
Over the last 15 years, Dr. Lavenson has developed a stroke prevention screening protocol that includes three simple, inexpensive tests: a blood pressure measurement, a quick ultrasound scan of the carotid arteries, and an electrocardiogram. In his practice setting, this screening takes 4 minutes and costs about $20 per patient.
The Carotid Quick Scan, developed by Dr. Lavenson and his associates, has a sensitivity of 93% and a specificity of 87%, compared with a full carotid ultrasound, and takes less than 1 minute. The ECG rhythm strip is done in under 2 minutes, and the blood pressure determination takes under 2 minutes with their machine. Hospitals using their protocol or a similar one usually are able to screen about 15 seniors an hour.
"The three main medical conditions that cause the majority of strokes are carotid artery disease, atrial fibrillation, and high blood pressure," said Dr. Lavenson, a vascular surgeon with Kaweah Delta District Hospital, Visalia, Calif. "Since these are silent 80% of the time, why not use an easy screening test to find them?"
In a study of the protocol, used in 2,532 patients aged 60 and older in central California, 746 patients (30%) were found to have high blood pressure, 189 (7.5%) were found to have carotid artery stenosis that exceeded 50%, and 128 (5%) were found to have atrial fibrillation.
An additional 3,514 elderly people were screened at more than 60 other medical institutions as part of a national study supported by the American Vascular Association, which endorses the protocol. That study yielded similar results.
"Medicare should pay for the screening like they do for Pap smears, prostate-specific antigen tests, and mammograms," Dr. Lavenson said at the conference, which was sponsored by the American Stroke Association. "It should be available to seniors over 60, especially at the time of their annual exam. We have an opportunity to reduce a major disease on an epidemiological scale by finding the silent causes of stroke."
Dr. Lavenson estimated that such screening would save more than $12 billion annually in health care costs.
BY DOUG BRUNK
San Diego Bureau
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|Title Annotation:||Geriatric Psychiatry|
|Publication:||Clinical Psychiatry News|
|Date:||Jul 1, 2004|
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