Heart & Stroke - Q1 - Mar 2019

Q1 / 2019 A SUPPLEMENT BY MEDIAPLANET DISTRIBUTED WITHIN THE IRISH INDEPENDENT

DR ANGIE BROWN Eight simple ways to manage your blood pressure. » p2

JIM REIDY “Keeping your body active is great, but keep your mind active as well.” » p4

PROFESSOR ANNE HICKEY “Cognitive impairment after stroke is an underresearched topic internationally.” » p6

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PAUL KEOGAN “I am the exception, not the rule and it needs to be the other way around.” » p6

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CREDIT: PARALYMPICS IRELAND

Heart and Stroke

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Why you need to know your blood pressure We’ve all heard of high blood pressure, but you may not be aware of its nickname – ‘the silent killer’. While it usually has no symptoms, high blood pressure is one of the most significant risk factors for heart disease and stroke.

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wo numbers are used to measure the level of your blood pressure. One number records blood pressure when the pressure is at its highest (as the heart muscle squeezes the blood out of your heart) – this is called systolic pressure. The second number records when your heart relaxes and allows the blood to flow back into the heart – this is called diastolic pressure.

High blood pressure means the pressure in your arteries is higher than it should be. This higher pressure puts extra strain on your heart and blood vessels. Over time, this extra strain increases your risk of heart disease and stroke.

The normal level of blood pressure is usually about 120 over 80. If your blood pressure is 140 over 90 or higher (or 140 over 80 if you have diabetes), you should discuss this reading with your doctor.

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Over one million people in Ireland have high blood pressure More than one million people in Ireland currently have high blood pressure. However, almost half of these people aren’t aware of this fact. The number of people in Ireland with high blood pressure is expected to grow, and it has been predicted to reach almost 1.3 million people by 2020.

High blood pressure is more common among older people. In 2010, almost three-quarters of adults aged 65 or older in Ireland had high blood pressure and almost half of adults aged 45-54 had high blood pressure.

What are the causes of high blood pressure?

There are several potential causes of high blood pressure. In some people, an unhealthy lifestyle contributes to it.

As we grow older, our blood pressure increases.

Being overweight, drinking too much alcohol, eating too much sodium (found in salt) and not eating enough fresh fruit and vegetables may also lead to an increase in blood pressure. High blood pressure also tends to run in families.

In a very small number of people, there is a specific underlying cause for high blood pressure such as kidney problems, adrenal gland tumours and thyroid problems.

Treating these conditions may result in your blood pressure returning to normal.

What can I do about it?

The good news is that it is possible to detect and treat high blood pressure. The only way to know if you have high blood pressure is to have it measured. Many factors can affect your blood pressure and so one high reading does not

DR ANGIE BROWN Medical Director, Irish Heart Foundation and Consultant Cardiologist

necessarily mean you have high blood pressure. This is why it is important to have it checked regularly, particularly if it has been elevated.

If you have been prescribed blood pressure tablets, it is important you take them regularly and your blood pressure is rechecked to make sure your blood pressure is being managed.

If you are 30 or older, it is best to have your blood pressure checked every year. You can get your blood pressure checked by your GP, in some pharmacies or in the Irish Heart Foundation’s mobile health unit.

Eight simple ways to manage your blood pressure 1. Know your blood pressure

3. Eat less salt and processed food and eat more fruit and vegetables 4. Drink less alcohol 5. Be more active 6. Don’t smoke 7. Manage your cholesterol 8. If you have been prescribed tablets for high blood pressure, take them.

The Irish Heart Foundation’s Mobile Health Unit offers free blood pressure checks around the country – visit our website irishheart.ie to see when it is coming to a location near you.

2. Aim for a healthy weight

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How to lead a normal life with atrial fibrillation Byline: Alex van den Broek

Six months after Jim Reidy had a stroke, he was diagnosed with atrial fibrillation. Now, he lets us in on how he’s led a ‘completely normal life.’

Atrial fibrillation affects people differently. In my case, I have two or three episodes a year and the danger is a clot forming in the heart. That’s why I‘m on medication.”

How did you find out you had atrial fibrilation?

It wasn’t until I had a stroke about three years ago. I exhibited all the signs of the FAST [Face, Arms, Speech, Time stroke response acronym], as the muscles on one side of my face dropped, I couldn’t speak and lost strength in one arm. It was a bit of a surprise because, even though I was 70, I was in fit enough shape.

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At that stage, the doctors didn’t know what caused the stroke, so they gave me an external heart monitor.

That’s when they diagnosed atrial fibrillation.

What does it mean to live with atrial fibrillation?

Some people don’t even know they have it. I didn’t know I had it until I got the stroke. I could have been living with it for about ten years before the diagnosis! But, since diagnosis and treatment, atrial fibrillation doesn’t affect my day-to-day whatsoever.

I joined a rehabilitation programme with Croí, the heart and stroke charity based in Galway, and learnt to pay attention to what I eat – minimise fatty foods,

eat plenty fruit and veg, and I can’t drink much alcohol. I still take part in the programmes there, and my wife joins me now too. I exercise five times a week, just a 40-minute brisk walk to get the heart muscles pumping.

What treatment have you undergone?

Atrial fibrillation affects people differently. In my case, I have two or three episodes a year and the danger is a clot forming in the heart. That’s why I’m on medication.

I’m incredibly happy with the treatment I’ve received from professionals – in Galway, Dublin and through support groups. Thankfully, I can live a completely normal life.

JIM REIDY Atrial Fibrillation Patient

What support have you found helpful?

The programmes at Croí are varied, and all have been fantastic.

I go to the Stroke Support Group once a month where we chat about our various experiences and the Croí health team (cardiac nurse specialists, dietitians, physiotherapists) guide us on diet, exercise and supporting mental health; all the various issues you can face.

One of the first programmes I took part in was a mindfulness programme, which is most related to effectively dealing with the anger you can feel after having a stroke and the emotional impact it can have. It runs alongside the exercise programmes and health talks at Croí – the support is absolutely fantastic.

What advice would you offer other patients with atrial fibrillation?

The first thing is to take your medication – it can be life saving.

Secondly, keep doing what your doctor tells you. Keep active, eat well, and don’t eat fatty, salty or sugary foods. Thirdly, keeping your body active is great but keep your mind active as well… don’t be afraid to seek support.

They sound like basic things, but you know what they say, ‘Some people never learn.’ We’ve heard this in so many ways, from the press to health journals and still people don’t bother, but seriously, consult your GP and get your heart checked!

Read more at healthnews.ie

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What you need to know about atrial fibrillation

Byline: Tony Greenway

Atrial fibrillation is a common heart rhythm disorder, the risk of which increases with age. Its symptoms should never be ignored, however, as it can be a warning sign of stroke.

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he good news is that we are all living longer, says Prof.

Ronan Collins, national clinical lead for stroke and codirector of atrial fibrillation clinic and at Tallaght Hospital, Dublin.

The challenging news is that, as we age, our chances of developing age-related diseases and disorders increases. One of these age-related conditions is atrial fibrillation (AF), a heart rhythm irregularity that shouldn’t be ignored as it is a major risk factor for stroke.

“Atrial fibrillation is the commonest rhythm disorder affecting the heart,” explains Prof.

Collins. “Around 5% of people over the age of 60 have it, and around 10% over the age of 75 have it. As populations age, we will see an increase in the numbers of AF cases.”

The heart is both a mixer and a pump for our blood. In AF, the atria — the ‘mixer’ and upper chamber of the heart — is affected by rhythm abnormality and no longer mixes blood effectively. “There is then a possibility that clots can form” says Dr Collins. “If these clots form and fall out of the mixer into

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the ventricle (‘pump’ and lower chamber) they can be pumped around the body and may jam in a small blood vessel, obstructing blood flow. As one of the first major blood vessels leaving the system travel to the brain, the clot formed in AF causes frequently interrupts blood flow to the brain, causing stroke; occasionally such clots may travel to affect circulation to limbs, gut and other organs, such as kidney, causing significant damage.”

Sometimes, atrial fibrilation has no symptoms People with AF may have few, or even no symptoms, making diagnosis complicated. “Occasionally, if the rhythm irregularity quickens, it may be felt as a palpitation or fluttering feeling in the chest,” says Prof. Collins.

“This may be associated with breathlessness or even chest pain, or a feeling of light headedness and fatigue. At least half of all cases come and go intermittently, often referred to as paroxysmal atrial fibrillation.” Worryingly, however, the first and only symptom can

be a when stroke occurs; which is why those with AF are usually prescribed blood thinners for life.

The higher your BMI and blood pressure, the harder your heart has to work People who develop hypertension (high blood pressure) in younger life are also at an increased risk of developing AF. “Sustained hypertension results in the heart muscle becoming stronger and thicker,” says Prof. Collins. “But this means the atria have to work harder, becoming larger and widening under stress, and this is often the first step to developing AF.” Controlling blood pressure is therefore important, as is maintaining an ideal body weight, because the higher your body mass index, the harder your heart has to work, the stiffer the heart muscle becomes, and the greater strain put on the atrium (‘the mixer’).

Newer anticoagulants reduce risk of stroke There are a number of treatment options for AF patients, both to restore the rhythm of the heart and

PROFESSOR RONAN COLLINS Clinical lead for Stroke and Co-Director, Atrial Fibrillation Clinic

prevent the major complications such as stroke. These include Direct Current Cardioversion, which administers a brief electric shock to get the heart back into a regular rhythm; a more invasive procedure called an ‘ablation’ where a catheter is placed into the atrium of the heart, to detect and then ablate or neutralise the area of abnormal electrical activity causing the irregular rhythm.

However, the chances of direct current cardioversion or an ablation working or leading to sustained normal rhythm with age and certain other factors.

Drugs known as antiarrhythmics are often used to maintain the normal rhythm once restored or regulate the rate so that the AF doesn’t go too fast causing symptoms. This often leads to better pump function and the patient feeling better. B-Blockers are one example of such drugs. Perhaps the most important drugs in AF, are agents known as anticoagulants, which are used to prevent the major risk of AF, i.e. clot formation and stroke. Older anti-coagulants such as Warfarin, tended to produce

variable levels of blood thinning at various times in individual patients requiring very regular monitoring.

They had many Interactions with diet and drugs and as such were not ideal for the population most in need of protection in AF, i.e older people.

“Newer anticoagulants are more reliable,” says Prof. Collins and are the drugs of choice recommended by the major professional bodies.

“More crucially, the newer drugs are safer in terms of reducing the risk of bleeding to the brain.

When it comes to prescribing anticoagulants, most clinicians follow guidelines from the European Society of Cardiology (ESC), which advises on the threshold of risk and agents of choice to prevent stroke In AF. ESC firmly recommends the use of newer agents, sometimes referred to as Non Vitamin K t Oral Anti Coagulants (NOACS). As clinicians, it is vital to explain to patients the range of AF treatment options and the risks of stroke and bleeding they present in a language patients can relate too” Read more at healthnews.ie

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Why we need more support for young stroke survivors

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PAUL KEOGAN Paralympian for Ireland Irish Heart Foundation Ambassador

Paul Keogan is ‘the exception, not the rule’ as more and more young people are let down by stroke rehabilitation services.

Byline: Alex van den Broek

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oung stroke survivors are faced with services tailored for older and retired people and require additional support.

Paul Keogan had a stroke at 17 and managed to make a full recovery but it took more than just physiotherapy…

In 2009, Paul’s life changed forever. An innocuous elbow to the temple during a game of Gaelic football for his local team, resulted in a brain haemorrhage.

After a speedy recovery of just two weeks in Beaumont Hospital, Paul was discovered with a brain aneurysm, which required surgery. The surgery had a 97.5% success rate but, unfortunately, Paul was one of the unlucky few.

At just 17, Paul had a stroke, which began a road to recovery that would reveal shortcomings in HSE stroke rehabilitation for young patients.

What is post-stroke cognitive impairment?

First steps to recovery “At first, they told me I might never walk again, and they didn’t think I’d have the attention span to get my Leaving Certificates,” says Paul. “When you have a stroke, it’s very hard to gauge what your recovery will be like.”

After his stroke, Paul spent six weeks at Beaumont Hospital in Dublin and then received two weeks of ‘fantastic treatment’ at the National Rehabilitation Hospital in Dun Laoghaire.

“I was recovering well, and it’s generally good if you’re being sent home early. But that’s only true so long as you have access in your community to the right services,” says Paul. “Unfortunately, I didn’t, so I started to deteriorate when I got home.”

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Service shortages in the community Despite growing incidents of stroke among young people, services have stood still according to the Irish Heart Foundation (IHF).. A recent survey of 500 working-age stroke survivors found almost half (44%) of those who needed physiotherapy as part of their recovery had to pay for private sessions to access services or received no services at all.

Although Paul had access to a physiotherapist once a week, his recovery process was slow and ineffective without additional services.

“When you have a stroke, you need both a physiotherapist and an occupational therapist for fine motor function. My neighbour, a nurse, came to the house every day for a year to make sure I did my exercises,” says Paul.

Everyone deserves proper rehabilitation After five years’ recovery, Paul went on to represent Ireland in Athletics at the Rio 2016 Paralympics, the World Para Athletics Championships and the European Championships 2018. However, without the additional help, Paul believes he would never have reached the level of mobility he has now.

“I am the exception, not the rule and it needs to be the other way around,” says Paul. Having retired after last year’s European Championship, Paul is excited to start ‘a new chapter’ of his life and continues to push for better stroke support for those who need it.

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PROFESSOR ANNE HICKEY Professor, Psychology and Deputy Dean, Positive Education RCSI, Division of Population Health Sciences, Royal College of Surgeons in Ireland

Stroke is a leading cause of death and disability worldwide and will increase considerably in coming decades as people live longer. any people are aware of the physical disabilities after stroke but are less aware that of the cognitive problems that can also arise, such as impaired memory and concentration. Often, stroke survivors can find these problems the most debilitating consequences.

Dementia can occur as a result of stroke Cognitive impairment after stroke is an under-researched topic internationally and is a critical area to better understand. While cognitive impairment after stroke is frequently mild or moderate, one in ten people can develop dementia after their first stroke, and more than one in three people who have a recurrent stroke may develop dementia.

The StrokeCog study, led by Professor Anne Hickey at RCSI in partnership with colleagues in Beaumont Hospital and the Economic and Social Research Institute (ESRI), involves modelling and modifying the consequences of stroke-related cognitive impairment through an intervention.

Physical rehab gets more attention than mental rehabilitation Rehabilitation of cognitive

difficulties has received very little attention compared with physical rehabilitation. The StrokeCog study aims to address the lack of research in this area by examining stroke-related cognitive impairment in a number of ways: 1. Building an innovative, epidemiological model that tracks post-stroke cognitive impairment and dementia progression over time, projecting from now until 2046, and evaluating the effects of introducing cognitive rehabilitation post-stroke to reduce the impact of cognitive impairment.

2. Working with patients, family members and healthcare professionals in stroke, to develop and test a post-stroke cognitive rehabilitation intervention in a pilot randomised controlled trial.

3. Costing post-stroke cognitive impairment and its continuum to dementia, and conducting an evaluation of the potential cost-effectiveness of cognitive rehabilitation interventions to reduce post-stroke cognitive impairment.

projections and costings with the development of an intervention to address cognitive impairment after stroke. This provides vital information to the Irish and international stroke community that is not currently available. This includes information on the extent of post-stroke cognitive impairment currently and in the next 25 years, the associated costs to the healthcare budget of post-stroke cognitive impairment, and the feasibility of introducing a cognitive intervention to rehabilitate those who experience cognitive impairment after stroke.”

A conference is planned for 2020, involving patients and family members, along with national and international stroke experts, in presenting StrokeCog, perspectives and current evidence.

Conference details to de confirmed however, please see our website strokecog.ie and follow us on social media for news and updates.

Speaking on the StrokeCog study, Professor Hickey said, “The StrokeCog study combines population level

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