This article was originally published on Atlanta Business Chronicle on May 19, 2023.

Stroke is the fifth leading cause of death in the United States. The Georgia Department of Public Health reports the state had the 12th highest stroke death rate in the country. Georgia is also part of the “stroke belt,” an area of the southeastern United States with stroke death rates 30% higher than the rest of the nation.

As the leading — but preventable — cause of disability, stroke can happen at any age.

Stroke is a medical emergency, meaning the blood flow to an area of the brain is cut off, depriving brain tissue of oxygen and nutrients. When this happens, brain cells start to die and abilities controlled by that area of the brain, such as speech or muscle control, are lost.

New drugs and new advanced treatments — such as the Tigertriever and Artemis — are helping reduce the death and disability impact of stroke, as well as comprehensive care programs and innovative hospital partnerships that expand stroke services into rural areas.

Physicians from Wellstar Health System and the CEO of a hospital in northeast Georgia joined Atlanta Business Chronicle to discuss stroke prevention and the future of stroke care.

Panelists & moderator

• Dr. Rishi Gupta, Endovascular Neurologist and Co-Medical Director of Neuro Care
• Dr. Ashis Tayal, Vascular Neurologist, Wellstar, Director of Neuro Care Network
• Van Loskoski, CEO, Stephens County Hospital
• David Rubinger, Market President & Publisher, Atlanta Business Chronicle; Moderator

What is stroke, screening and secondary prevention

David Rubinger: Dr. Tayal, set the stage for us about the definition of stroke.

Dr. Ashis Tayal: A stroke is a sudden injury of the brain due to blockage or rupture of an artery in the brain. Injuries to the brain and disability can vary significantly.

The most common, ischemic stroke injury, is due to obstruction of an artery that causes a loss of blood flow to a critical part of the brain which damages the brain rapidly.

The other type of stroke is hemorrhagic stroke, where there’s a rupture of an artery, bleeding into the brain, or the surfaces of the brain, and that is called an intracerebral hemorrhage or a subarachnoid hemorrhage.

Rubinger: I think Americans have become a little better educated as to who’s at risk for stroke, but why don’t you walk us through that. Who would be a potential stroke candidate?

Tayal: High blood pressure, or hypertension, is the most common risk factor for both ischemic and hemorrhagic strokes. High blood pressure is an extremely common but controllable condition. Almost 80% of people have hypertension as they’re getting older.

Other risk factors include diabetes associated with elevated blood sugars causing accelerated blockage of arteries and high cholesterol, which can be related to diet and genetics.

Atrial fibrillation, a common heart arrhythmia that occurs as people get older, also places people at risk for the most severe and disabling types of strokes. And plaque buildup in specific arteries of the neck and brain also leads to an increased risk of stroke.

Smoking is another risk factor. Many adults still smoke despite a lot of progress in stroke treatment, and smoking puts people at risk for different types of stroke.

Rubinger: What about atmospheric things like stress and other areas like that? How does that play into it? Or do those things manifest themselves because of the other underlying physical conditions?

Tayal: I don’t view stress, in and of itself, as a risk factor for stroke. I think that’s more related to people’s environments and their own personalities and how they respond to stress. I do think people who are under undue stress can have poor lifestyle habits, and those poor lifestyle habits, whether poor eating habits, smoking, weight gain or lack of exercise, can lead to conditions that increase the risk for stroke.

Rubinger: So how is the healthcare system doing treating strokes? Do you believe that what’s going on at the primary care provider’s office is helping or do we have a way to go?

Tayal: In the United States, preventive care has improved the treatment of risk factors that lead to stroke, but communities must maintain routine checkups as many of the risk factors are silent.

There are improved treatments for hypertension, more aggressive treatment for diabetes, and more efforts at smoking cessation. Just the fact that we treat hypertension better than we did a generation ago has had a great impact on lowering the prevalence of stroke.

That being said, some of the most exciting work on stroke has often been done in the area of acute treatment of stroke with clot-busting drugs, catheter-based treatments and medications to protect the brain during an acute injury.

Rubinger: Has pharmacology gotten better in terms of the hypertension medicines that are out there? Have anti-cholesterol medicines improved in recent years?

Tayal: In the past, healthcare providers were often undertreating people with hyperlipidemia — high cholesterol — and not fully appreciating the benefits of significant reductions in cholesterol levels. For example, we’ve learned that driving cholesterol down into much lower ranges under 55 mg/dL can benefit our patients who have vascular disease as a cause for their stroke.

In the fight against high cholesterol, newer medications that prevent the absorption of cholesterol are now available. Recent developments have led to the discovery of a new underutilized class of drugs called PCSK-9 inhibitors that are highly effective.

To address the growing need for hospital beds in Acworth and the surrounding areas, Wellstar Health System is proposing to build a new 230-bed hospital, filing its Letter of Intent with the Georgia Department of Community Health. A Letter of Intent is the first step in the process to obtain a Certificate of Need for a new hospital.

The new hospital would be located on Cobb Parkway across from the Wellstar Acworth Health Park. Wellstar’s long history of service to this community makes it the ideal partner to continue to meet the area's growing healthcare needs. The project will be supported by Wellstar Health System resources, including Wellstar Kennestone Regional Medical Center and Wellstar Paulding Medical Center, and numerous primary, urgent and specialty care locations, which will further enable the project to provide high-quality care in an integrated, coordinated and efficient manner.

Wellstar will file a detailed Certificate of Need application on or before June 23, 2025, that will include architectural renderings and how the hospital would address the community’s health and wellness needs.

“Wellstar is improving access to care, and this new hospital is the latest in a series of projects that do just that,” said Candice L. Saunders, president and CEO of Wellstar Health System. “The area is growing so much that even when our new tower at Wellstar Kennestone opens next year, the region will need more hospital beds. A new hospital in Acworth would fill a crucial need for the region’s medical care.”

Wellstar is improving access to care for communities across Georgia through more than $1.4 billion in major projects, including:

• Expanding Wellstar Kennestone with a new 200-plus bed tower for additional specialty care,
• Expanding Wellstar Paulding with a new 56-bed tower and parking deck to meet growing community need,
• Adding a new oncology center to Wellstar Spalding Medical Center to help keep cancer care local,
• Committing to upgrading and expanding facilities in the Augusta area, including building a new 100-bed hospital and medical office building in Columbia County for the largest county in Georgia without its own hospital,
• Adding primary care, pediatric, urgent care and specialty services in the communities Wellstar serves, and
• Partnering with the Augusta University Medical College of Georgia Center for Digital Health to provide rural hospitals with access to specialty care.

The new hospital would be part of a Wellstar system that provides more than $1 billion each year in charity and uncompensated care—more than any health system in Georgia. Wellstar is also a leader in medical education through its partnerships with academic institutions, accelerates healthcare technology and innovation, and is recognized by Fortune magazine as one of the 100 Best Places to Work in America.

“Access to healthcare has been expanding throughout Cobb County, but we still have an unmet need for hospital beds in the northern portion of our county,” said Lisa Cupid, chairwoman of the Cobb County Board of Commissioners. “Wellstar is deeply committed to our region, and we’re grateful that they recognized this need and are stepping forward with a solution.”

“Acworth’s population grew fivefold in ten years, and we continue to attract people who want to live and work in our area,” said Tommy Allegood, mayor for the City of Acworth. “The City of Acworth has been expanding our critical infrastructure and creating a place where families will want to stay for generations. A hospital would be extremely beneficial to our community, and we appreciate Wellstar’s willingness to meet our need.”

Wellstar is headquartered in Cobb County and is deeply involved in the area, tracing its heritage to 1950 when Kennestone Hospital opened. In keeping with its community roots, Wellstar will establish a community advisory council to honor every voice throughout the Certificate of Need process.

“My patients are from all walks of life, but they share a desire for a hospital that’s closer to home, especially those who have chronic conditions or are elderly,” said Dr. Michaele Brown, a Wellstar primary care doctor in Acworth. “We live in a vibrant, growing area. Our patients’ access to all levels of healthcare should be just as vibrant and that includes a hospital where they can quickly get the level of care they need when they need it.”

“We will involve the community in every step of this process, and make sure this hospital meets the community’s needs for generations to come,” said Saunders.

In addition to providing care for generations of families, Wellstar actively supports community health and well-being through partnerships with nonprofit, civic and business organizations, as well as academic institutions. Through these partnerships, Wellstar serves all of its neighbors’ needs, ranging from access to healthcare to food and housing insecurity to educational support and career development.