Stroke Care Costs Projected to Double

The costs of treating stroke will more than double by 2030, a new report says. The main reason given is the aging of the U.S. population. American Heart Association and the American Stroke Association released the policy statement. It predicts that the actual number of strokes will rise 20%. Stroke care costs are projected to jump from about $72 billion in 2010 to $183 billion in 2030. The result will be a strain on the health care system, an expert told HealthDay News. Lost productivity would cost another $57 billion, the policy statement says. That's up from $34 billion in 2010. About 90% of people who survive a stroke are left with some type of disability. Strokes are expected to increase most among people ages 45 to 64 years old, and among Hispanics. The journal Stroke published the statement. HealthDay News wrote about it May 22.

By Robert H. Shmerling, M.D.
Harvard Medical School

What Is the Doctor's Reaction?

Stroke is the fourth leading cause of death in the United States. And it could move even higher on the list. Advancing age is a major factor that increases the risk of stroke. The aging of the baby boomer generation is expected to contribute to rising stroke rates in the coming years.

So it should not be surprising to learn that experts also predict an increase in the costs of caring for people with stroke. What surprised me is how much of an increase.

A new report in the medical journal Stroke predicts these changes by 2030:

• The number of people having strokes will increase by 20%.
• The costs to care for people with stroke will more than double. Compared with current spending, that's an increase from $72 billion to $183 billion. And that doesn't count $57 billion in lost productivity.
• The biggest increases in stroke are expected to affect those ages 45 to 64, Hispanics and the uninsured.

These estimates are clearly cause for concern. But I think they also represent an opportunity. There is much that can be done to reduce the number of strokes in the future.

What Changes Can I Make Now?

Changes you make now can reduce your chances of having a stroke.

Learn about the factors that increase the risk of stroke and what you can do about them. They include:

• Inactivity -- Exercise for at least 45 minutes most days of the week.
• Smoking -- If you smoke now, make a commitment to quit. If you cannot quit on your own, ask your doctor about programs that can help. Avoid secondhand smoke as well.
• High blood pressure (hypertension) -- Have your blood pressure checked regularly. If it's high, cut back on salt and lose excess weight. If necessary, take medicines your doctor recommends.
• Diabetes -- Medicines, changes in diet and loss of excess weight may reduce your risk of diabetes-related health problems, including stroke.
• Obesity -- Excess weight increases the risk of diabetes, high blood pressure and other risk factors for stroke. Therefore, it's helpful to maintain a healthy weight.
• An unhealthy lipid profile -- If you have blood lipids (such as total and LDL cholesterol) that are not in an ideal range, talk to your doctor. Diet, exercise and medicines often can improve them.
• Atrial fibrillation -- This is a type of irregular heartbeat. Your doctor may detect it during routine medical care or while evaluating symptoms. For example, you may have palpitations or feel lightheaded. If you have atrial fibrillation, consider taking a blood thinner, such as warfarin (Coumadin), which can lower the risk of stroke.
• Narrow carotid arteries -- The carotid arteries are in the neck and supply blood to the brain. If narrowed by atherosclerosis, they can be opened up with a surgical procedure. This improves blood flow to the brain and reduces the risk of stroke.
• Depression -- Recent studies have shown a link between depression and stroke. However, we don't know whether treatment of depression lowers stroke risk.

Find out if you have a family history of heart and blood vessel disease, such as heart attack or stroke. If you have a strong family history, changing your other risk factors is even more important.

Know the symptoms of stroke. Prompt treatment by experienced stroke experts gives you the best chance for a good recovery. If you have stroke symptoms, call for emergency care right away.

Symptoms of stroke usually occur suddenly. They may include:

• Confusion
• Trouble speaking or understanding what is said
• Difficulty walking or loss of balance
• Vision loss
• Numbness or weakness of one side of the body or face
• Severe headache

Plan ahead. If you have risk factors for stroke, talk to your doctor about which hospitals near you are able to provide state-of-the-art stroke care.

What Can I Expect Looking to the Future?

Future research may help explain why some people are more likely to have a stroke than others. For example, it's not clear why Hispanics are at higher risk than other ethnic groups.

If we reduce our risk factors, we can prevent many strokes. Universal health insurance coverage and a focus on preventive health measures could also help reduce strokes. These are two key goals of the 2010 Affordable Care Act.

With these positive changes, we may be able to avoid a dramatic increase in stroke rates and costs of care. If so, today's estimates could prove to be a "worst case scenario" that never actually happens.