JFK UNIVERSITY MEDICAL CENTER AND JFK JOHNSON REHABILITATION INSTITUTE LEAD THE STATE IN THE ADVANCEMENT AND CARE OF STROKE PATIENTS – ADDRESSING BOTH THEIR MEDICAL AND PHYSICAL NEEDS
BY JESSICA JONES-GORMAN • PHOTOS BY AMESSE PHOTOGRAPHY
As the first tertiary care hospital in the state to receive stroke center accreditation, JFK University Medical Center has consistently led the state of New Jersey in stroke care. Through both its specialized rehabilitation hospital, JFK Johnson Rehabilitation Institute, which provides expert rehabilitative care for survivors of stroke, and the JFK University Medical Center Neuroscience Institute, responsible for advanced research and development in the immediate treatment and prevention of stroke, JFK remains at the forefront of advanced medical and physical stroke care in the Garden State.
Hackensack Meridian JFK Johnson Rehabilitation Institute recently released a groundbreaking research study detailing how stroke survivors can substantially reduce their chances of morbidity. Spearheaded by Sara Cuccurullo, M.D., and Talya Fleming, M.D., the report, which spans several years of extensive research, identifies the benefits of a comprehensive program of cardiac conditioning and lifestyle counseling for patients who are at risk of recurrent stroke.
For the co-principal investigators of the JFK Johnson Stroke-HEART™ Trials, the international recognition the study has received has been revolutionary. And for residents of New Jersey who may require these services in the future the research performed by this team offers life-saving promise. “The risk of having a recurrent stroke in the first year post-stroke is upwards of 12% to 25%,” noted Dr. Cuccurullo, vice president and medical director of JFK Johnson Rehabilitation Institute. “So we started brainstorming, thinking of ways to improve those outcomes. What practices could we implement to reduce those numbers?”
Modeling a process for stroke recovery after the 36-session rehabilitation offered for cardiac care, which has been proven to reduce the mortality rate of cardiac patients with stent placement by 45%, Dr. Cuccurullo and Dr. Fleming modified the rehab, structuring the program to help stroke survivors adopt appropriate behavioral and lifestyle changes.
“Cardiac rehab reduces the risk of future events and has had amazing outcomes,” said Dr. Cuccurullo. “We modified that same program for stroke patients and launched the trials at JFK Johnson. Our outcomes were so amazing we have since presented our program nationally with the American Heart Association and have been invited to present internationally in Japan and the United Kingdom. It’s really gaining traction and the medical community as a whole is really interested in our research and our outcomes.”
The study is revolutionizing the way the medical community thinks about stroke recovery. Following 783 patients with strokes serious enough to require inpatient rehabilitation, participants were offered cardiac conditioning in addition to physical, psychological, nutritional, and educational support. While 473 of those patients chose the traditional standard of care, including physical, occupational and speech therapy, and regular physician follow-up, 136 opted to participate in JFK Johnson’s Stroke Recovery Program. Of the 473 patients in the standard of care, 60, or 13%, died during a median follow-up of 85 days. In contrast, two of the 136 patients, or 1.47%, died during that same time frame.
“The results were astounding,” said Dr. Cuccurullo. Using recumbent cross training exercise equipment, the team focused much of its attention on physically accommodating patients with paralysis or other symptoms of stroke.
“As physical medicine and rehabilitation physicians, we know how to get people with serious neurologic impairment moving,” explained Dr. Cuccurullo. “There was this thinking that you can’t get stroke patients to exercise. But we found that with some modifications stroke patients can exercise safely. And we are finding the benefits to be substantial.” In addition to 36 sessions of medically monitored interval cardiovascular training and traditional physical, occupational, and speech therapy, patients were given psychological, nutritional, and educational support as well as risk factor management, such as smoking cessation.
“What’s special about our program is that we take it to another level,” noted Dr. Fleming, director of JFK Johnson’s Aftercare and Stroke Recovery Programs. “This is a mini cardiac rehab designed exclusively for stroke survivors and in 36 sessions we cover it all: nutrition, mood, even physical functions like driving, which are necessary to return to daily life. One in four stroke patients will have another stroke so we make sure to talk about the warning signs and what to do in an emergency. This is a major breakthrough for stroke survivors, and we are realizing that the program itself is having a big impact. We’ve seen an improvement in cardiac capacity of 103% and the one-year all-cause readmission rate for stroke has decreased by 22%. Those are numbers of which we are extremely proud.”
The results were so impressive, in fact, that in a sub-analysis the JFK Johnson researchers compared patients of similar gender, age, race, and medical complexity and found those who did not complete the program were nine times more likely to die than those who did complete the program. Bottom line? A comprehensive stroke recovery program can help stroke survivors live longer, healthier lives.
The Stroke and Neurovascular Center at JFK University Medical Center also continues to strive to advance stroke care for patients. Tenecteplase, an alternate type of tissue-type plasminogen activator (tPA), is being used to treat patients with acute ischemic stroke.
“For a long time IV alteplase was the only clot busting medication that was available to give to patients within four-and-a-half-hours of stroke symptom onset,” noted Spozhmy Panezai, M.D., stroke director at JFK University Medical Center and associate professor at Hackensack Meridian School of Medicine.
“There have been many recent studies that have shown the advantages of using tenecteplase over alteplase and published guidelines that have endorsed its use in select patients,” continued Dr. Panezai. “Some of these advantages include longer half-life which allows it to be given as a single-bolus injection instead of an infusion, as is the case with alteplase. Unfortunately with infusions you need more equipment and people at the bedside, which not only can cause delays in treatment, but in patients with COVID, it increased unnecessary exposure.”
Tenecteplase has also been shown to be more effective in treating certain types of stroke, especially where a large blood vessel is blocked.
“Our multidisciplinary stroke team jumped on the opportunity to bring it to JFK,” continued Dr. Panezai. “But just like with any new treatment, you want to make sure that it can be given safely and to the right patients.”
Hackensack Meridian JFK University Medical Center’s Stroke and Neurovascular Center at the Neuroscience Institute started using tenecteplase in October 2020, and Dr. Panezai noted the results have been extremely positive so far.
“Tenecteplase has been effective at times in opening up blood vessels on its own,” explained Dr. Panezai. “What this means is that we may be able to avoid performing mechanical thrombectomies (a minimally invasive interventional procedure that removes blood clots from a blood vessel) and save patients from going through a whole procedure.”
For Hackensack Meridian Health, it’s just one part of the rapid innovation developing for stroke patients.
“There is a lot of exciting advancement in this field,” added Dr. Panezai. “And I look forward to what the future will bring.”
JFK University Medical Center
65 James Street, Edison / 732.321.7000 / jfkmc.org