New Minnesota grant aimed at multicultural stroke prevention

The American Heart Association (AHA) announced the beginnings of a new three-year $4.7 million initiative at a Sept. 26 press conference in the Capitol rotunda. 

This initiative began with a $4 million grant from the Leona M. and Harry B. Helmsley Charitable Trust Foundation and will fund the creation of linguistically and culturally appropriate materials for stroke awareness and prevention for various communities and refine care in treatment facilities around Minnesota. 

“Minnesota has been doing excellent stroke care from the very beginning and has had lots of improvement,” said Walter Panzirer, a trustee with the Helmsley Charitable Trust.“This grant will fill in the gaps.”

“So much of the language or availability of education, prevention, information (and) awareness (concerning strokes) is all in English or Spanish, which leaves out entire populations of people, particularly in Minnesota with the changing demographics and even more aligned, changing demographics in rural areas,” said Lauren Rauscher, a national executive in the Mission Advancement division of the AHA. “(The materials) will be developed in partnership with communities, so it will be a trans-creation process where it’s not simply translating into different languages but understanding substantive meaning and cultural context.” 

As an example, Rauscher pointed to acronyms for stroke response. The Spanish acronym is RAPIDO – Rostro caído (drooping face) , Alteración del equilibrio (change in balance) , Pérdida de fuerza en un brazo o pierna (loss of strength in arms or legs) , Impedimento visual (visual impairment), Dificultad para hablar (difficulty speaking), and Obtenga ayuda rápido (obtain help quickly). This fulfills the same step by step identification of symptoms and call to action as the English acronym, which is BE FAST – Balance changes (inability to walk or loss of balance), Eyes (vision changes, including blindness or double vision), Face drooping, Arm weakness, Speech difficulty, and Time to call 911.

The awareness materials, said Rauscher, will be available in a variety of ways, from print to social media. “We will look for different places to meet community members where they are, whether that is in a library, in a school, through public service announcements, materials in physician(s’)offices or community centers,” added Rauscher. 

The specific languages these materials will be in have yet to be determined, said Rauscher, but the AHA’s community impact team will be identifying communities and people within these communities to partner with in the trans-creation process. 

In terms of the post-acute care segment of the initiative, said Panzirer, the AHA will be working with facilities in Minnesota to bring them up to the “gold standard of care.” This means wherever a patient lives – whether that’s a rural area,  in a suburb, or in an urban center– they are able to access the best possible care. 

Madeline Pawloski, a program consultant with the AHA, confirmed the AHA will not only work with facilities across Minnesota to implement the best standard of care, but will also utilize “monthly learning collaborative(s)” to bring facilities together, so that they may learn from each other. Pawloski also stated the AHA will be learning from the facilities what is needed in Minnesota specifically to benefit clients and work to build those capacities, “whether that’s educational resources (or) staff training, whatever it needs to be, that’s kind of the goal of the initiative – to really tailor it to Minnesota.”

The initiative, said Dr. Haitham Hussein, neurologist at the University of Minnesota and former board president of the AHA in the Twin Cities, has the potential to cut down on disparities in care. 

Research conducted by Hussein and other researchers indicated Hmong American stroke patients were found to have an average delay of four hours arriving at the emergency room after a stroke’s onset compared to white American patients. This delay has great impacts on outcomes. 

“There is a treatment we can give to reverse the effects of stroke, a clot buster medication,” said Hussein. “We can only give it within 4.5 hours from the time the person was last known well, and so when you come late, you know that chance then is not there anymore.And we don’t get the treatment. We found that delay, of course, led to Hmong Americans getting less treatment with the clot buster compared to white American stroke patients. And that impacted the outcome. Those who came early and were treated actually had similar improvement.” 

Another study authored by Hussein looked at non-white and white stroke patients in a different health care system. This study found that there was an even larger average delay of eight hours between stroke onset and hospital arrival. 

“We know from professional experience and our research that the first link in the stroke chain of survival is broken in individuals of racial minority groups,” said Hussein. “(There is a gap in) health literacy – knowing what stroke is and what to do – and this grant is going to address this gap and bring patients earlier to the hospital and allow us to provide the treatments that are proven to improve stroke recovery and outcome. On the other end, acute care is what happens after the patient is discharged from the hospital. They start their recovery journey (and) they go to a rehabilitation center. These rehabilitation centers are not evenly distributed in the state. There are some sophisticated, more stroke-specific rehabilitation services that might not be available in rural areas (that) are available in urban parts of the state. This grant is going to flourish the rehabilitation component of stroke care, too. It is really just a perfect grant for the perfect state, focusing on perfect goals.”

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