According to national estimates, stroke is the third leading cause of death among women in the United States, and the aftermath of these events is significant among survivors. Studies have found that about one-third of women who survive a stroke will need help caring for themselves, whereas 16% will require institutional care, and 7% will have an impaired ability to work. Each year, about 55,000 more women than men will have a stroke. There has also been a rise in stroke prevalence among middle-aged women that has not been seen in their male counterparts, highlighting the need for a better understanding of stroke among women of all ages.
Research has shown that women from racial and ethnic minority backgrounds experience a disproportionate stroke burden. For example, African-American women have an incidental stroke risk that is almost twice as high as that of Caucasian women. Some studies indicate that the prevalence of stroke risk factors may be higher among Hispanic women. “Considering these risks, it’s important to assess the ability of women to recognize stroke warning signs at their onset,” says Heidi Mochari-Greenberger, PhD, MPH. “Early recognition may lead to more rapid access to emergency care, which in turn may result in decreased stroke-related morbidity and mortality.”
Surveying the Scene
To improve outcomes and reduce disparities, it is important to address gaps in women’s knowledge as it relates to stroke warning signs. In 2012, the American Heart Association (AHA) commissioned a national survey to determine women’s cardiovascular disease awareness. This survey also included an assessment of knowledge relating to stroke warning signs. For a study published in Stroke, Dr. Mochari-Greenberger and colleagues evaluated the knowledge of stroke warning signs and intent to call 9-1-1 first if warning signs occurred. The analysis included more than 1,200 women aged 25 and older from various races and ethnicities.
According to the results, only about half of women surveyed could identify sudden weakness or numbness of the face or a limb on one side as a stroke warning sign (Figure). A little more than 40% of women identified that loss of or having trouble with talking or understanding speech was a stroke warning sign. This occurred more frequently among Caucasian women than those of Hispanic descent (Table 1). Fewer than 25% of women identified sudden severe headache, unexplained dizziness, or sudden dimness or loss of vision as warning signs. “One in five women was unable to identify a single stroke warning sign,” adds Dr. Mochari-Greenberger.
The majority of women in the study reported that they would call 9-1-1 first if they thought they were experiencing signs of a stroke (Table 2). “The encouraging news is that knowledge to call 9-1-1 was high and that this finding didn’t vary considerably among African-American, Hispanic, and Caucasian women,” Dr. Mochari-Greenberger says. However, while the percentages were all above or near 80% for women knowing to call 9-1-1 early, Dr. Mochari-Greenberger notes that there is still significant room for improvement. “Women were aware to call 9-1-1 if they experience signs of stroke or see them in others, but at least half might not be able to recognize the signs should they occur.”
Bridging Knowledge Gaps
Results from the study are consistent with other reports documenting that there is low knowledge of stroke warning signs among women in the U.S. “The AHA and other organizations have made great strides in increasing awareness of warning signs for heart attack among women,” says Dr. Mochari-Greenberger. “Our data highlight that there’s a knowledge gap among women specifically relating to stroke warning signs, and increased public awareness is needed.”
Patient education efforts for women are warranted, according to Dr. Mochari-Greenberger. “Several public awareness campaigns have been launched,” she says. “For example, the AHA and the American Stroke Association have issued the Spot a Stroke FAST campaign. The word FAST is an acronym for the groupings of warning signs, which include face drooping, arm weakness, speech difficulty, and time to call 9-1-1. The hope is that more efforts like this will reach diverse groups of women in the future. In the meantime, clinicians should engage their female patients with any risk factors for stroke about their knowledge of stroke warning signs.” Having an open conversation about it could mean the difference between life and death.
Readings & Resources (click to view)
Mochari-Greenberger H, Towfighi A, Mosca L. National women’s knowledge of stroke warning signs, overall and by race/ethnic group. Stroke. 2014;45:1180-1182. Available at: https://stroke.ahajournals.org/content/45/4/1180.full.
Mosca L, Hammond G, Mochari-Greenberger H, Rao S, Albert MA. Fifteen-year trends in awareness of heart disease in women: results of a 2012 American Heart Association national survey. Circulation. 2013;127:1254-1263.
Centers for Disease Control and Prevention (CDC). Disparities in deaths from stroke among persons aged < 75 years: United States 2002. MMWR Morb Mortal Wkly Rep. 2005;54:477-481.
Ferris A, Robertson RM, Fabunmi R, Mosca L; American Heart Association; American Stroke Association. American Heart Association and American Stroke Association national survey of stroke risk awareness among women. Circulation. 2005;111:1321-1326.
Cruz-Flores S, Rabinstein A, Biller J, et al. Race-ethnic disparities in stroke care: the American experience: a statement for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2011;42:2091-2116.